Additional ablation beneficial in reducing recurrence of OT-PVCs compared to single-point ablation strategy: JAMA

A new study published in the Journal of American Medical Association suggests that it is safe and beneficial to add further ablation lesions around the index effective location while employing ablation to outflow tract premature ventricular contractions (OT-PVCs).

Following ablation of outflow tract premature ventricular contractions, recurrence is still difficult to treat. While it is occasionally done to improve the ablation by adding further lesions adjacent to the initial successful ablation location, the efficacy of this strategy is yet unknown. Thus, this study by Kexin Wang and colleagues was set to investigate the hypothesis that, in comparison to single-point ablation at the index effective location for the ablation of OT-PVCs, multiple ablation lesions would lower the recurrence rate.

This prospective, multicenter, randomized clinical trial enrolled patients from October 2021 to February 2023, from 18 facilities in China where the patients went to get their first catheter ablation for OT-PVCs. 3 months were allotted for the follow-up period following the operation. The patients were randomized 1:1 into an additional ablation group or a control group following the identification of the target location and the single-point ablation's elimination of the PVC. Freedom from PVC recurrence (defined as ≥80% decrease in PVC load, or the number of PVCs in a 24-hour period divided by the total number of heartbeats in a 24-hour period x 100%) was the main goal of the study from the baseline to three months after the treatment.

A total of 286 individuals out of the 308 patients who were included in the trial were randomized to either the control group or the extra ablation. The control group (single-point ablation group) received a mean (SD) of 1 (0) radiofrequency application, whereas the additional ablation group had a mean (SD) of 6.3 (1.1) radiofrequency applications. The rate of independence from PVCs was substantially greater in the extra ablation group (139 of 142 [97.9%]) than in the control group (115 of 139 [82.7%]; P <.001) during a median (IQR) follow-up of 3.2 (0) months.

Also, the patients in the extra ablation group saw a more significant decrease in PVC burden when compared to the control group. In neither group did there exist any serious periprocedural problems. Overall, additional lesions next to the index successful ablation location considerably decreased the PVC load and recurrence rate without increasing adverse effects.

Source:

Wang, K., Yi, F., Xiao, F., Zou, C., Zhang, Y., Wang, Y., Shi, L., Li, C., Chen, L., Xie, S., Shen, W., Zhang, N., Wu, Q., Xu, Q., Ji, Y., Wang, C., Lin, Z., Wei, Y., Ruan, Z., … Cao, B. (2024). Additional Lesion Sets in Ablation of Outflow Tract Premature Ventricular Contractions. In JAMA Cardiology. American Medical Association (AMA). https://doi.org/10.1001/jamacardio.2024.2975