Catheter ablation of parahisian premature ventricular complexes in patients with and without cardiac scar

Jamie Simpson; Mohamed Al-Sadawi; Amrish Deshmukh; Jackson J Liang; Rakesh Latchamsetty; Thomas Crawford; Krit Jongnarangsin; Hakan Oral; Frank Bogun; Michael Ghannam

doi:10.1016/j.hrthm.2024.03.1813

Catheter ablation of parahisian premature ventricular complexes in patients with and without cardiac scar

Heart Rhythm. 2024 Apr 2:S1547-5271(24)02308-7. doi: 10.1016/j.hrthm.2024.03.1813. Online ahead of print.

Affiliations

¹ Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan.
² Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan. Electronic address: mousajab@med.umich.edu.

PMID: 38574787
DOI: 10.1016/j.hrthm.2024.03.1813

Abstract

Background: Ablation of premature ventricular complexes (PVCs) originating from the parahisian area is challenging. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) scar may influence procedural outcomes; the impact of cardiac scar on parahisian PVCs has not been described.

Objective: The objective of this study was to examine the incidence and significance of LGE-CMR scarring in patients undergoing ablation for parahisian PVCs.

Methods: Consecutive patients who underwent preprocedure LGE-CMR imaging and ablation of parahisian PVCs were included. Acute and long-term outcomes were examined.

Results: Forty-eight patients were included (male, n = 37; age, 66 ± 10 years; ejection fraction, 50% ± 12%; preprocedure PVC burden, 21% ± 12%). Intramural LGE-CMR scar was present in 33 of 48 (69%) patients. Cryoablation was used in 9 patients; ablation in multiple chambers was required in 28 (58%) patients. The PVC site of origin (SOO) was intramural (n = 25 patients), left ventricular (n = 5), and right ventricular (n = 18). Patients with LGE-CMR scar were more likely to have intramural PVCs (64% vs 27%; P < .04) and to require ablation in multiple cardiac chambers (58% vs 13%; P < .02). Patients with intramural scar required longer duration of ablation delivery (31 ± 20 minutes vs 17 ± 8 minutes; P < .02). Acute procedural success was 69%; PVC burden on follow-up was 6% ± 9% and similar for those with and without scar.

Conclusion: Ablation of parahisian PVCs often requires mapping and ablation of multiple cardiac chambers, with an intramural SOO identified in most patients. An intramural scar was associated with an intramural SOO of the PVCs requiring more extensive ablation procedures, with similar long-term outcomes compared with those without scar.

Keywords: Catheter ablation; Cryoablation; Late gadolinium-enhanced cardiac magnetic resonance; Parahisian arrhythmia; Premature ventricular complexes.