Аннотация:Background: Premature ventricular complex (PVC) ablation has been shown to improve left ventricular ejection fraction (LVEF) and functional class in patients with LV dysfunction. Both are considered key variables in predicting risk of sudden cardiac death. Objective: The objective was to assess whether ablation might remove primary prevention (PP) implantable cardioverter-defibrillator (ICD) indication in patients with frequent PVC. Methods: Sixty-six consecutive patients with PP-ICD indication and frequent PVC (50% men, aged 53 ± 13 years, 17% ischemic heart disease) underwent PVC ablation. ICD was withheld and indication was re-evaluated at 6 and 12 months. Results: LVEF progressively improved from 28 ± 4% at baseline to 42 ± 12% at 12 months (p < 0.001). NYHA class improved from 2 (3%) patients with NYHA-1 at baseline to 35 (53%) at 12 months (p < 0.001). BNP decreased from 246 ± 187 pg/mL to 176 ± 380 (p = 0.004). The PP-ICD indication was removed from 42 (64%) patients during follow-up, 38 (92%) of them at 6 months, showing an independent association with baseline PVC burden and successful sustained ablation (SSA). In patients with SSA, a cut-off value of 13% PVC burden had 100% sensitivity and 93% specificity (AUC 99%) for removing ICD indication post-ablation. No sudden cardiac deaths or malignant ventricular arrhythmias were observed. Conclusion: In patients with frequent PVC and PP-ICD indication, ablation improves LVEF and in most cases allows removal of the indication. Withholding the ICD and re-evaluating within 6 months post-ablation seems to be a safe and appropriate strategy. Heart Rhythm. 2015 Dec;12(12):2434–42
