Impact of Radiofrequency Ablation on Biventricular Myocardial Strain in Patients With Idiopathic Right Ventricular Outflow Tract Premature Ventricular Contractions: A Prospective Pre–Post Speckle-Tracking Echocardiography Study
Background:Idiopathic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) are associated with subclinical ventricular dysfunction despite preserved conventional systolic indices. Indeed, several studies have shown that speckle-tracking echocardiography (STE) enables sensitive assessment of longitudinal myocardial mechanics and may detect early functional recovery after catheter ablation.Methods:This pre–post observational study included 26 adults with an idiopathic RVOT PVC burden >15% who underwent catheter ablation. A STE and 24-hour Holter monitoring were performed at baseline and 3 months to assess left ventricular global longitudinal strain (LV-GLS), right ventricular free-wall longitudinal strain (RVFWLS), and right ventricular four-chamber longitudinal strain (RV4CLS). Associations between PVC burden reduction (ΔPVC%) and changes in strain were evaluated using correlation analyses, threshold-based comparisons, and exploratory multiple linear regression models adjusted for baseline strain and baseline PVC burden.Results:The study included 26 patients with a mean age of 46.7 ± 10.4 years; 23 patients (88.5%) were women. PVC burden decreased from a median of 20.5% (interquartile range [IQR] 17.8–20.5) at baseline to 1.5% (IQR 1–5.3) at 3 months. Furthermore, all strain indices improved significantly, including LV-GLS (−17.8 ± 3.4 to −20.9 ± 3.5), RVFWLS (−23.1 ± 4.3 to −28.3 ± 4.3), and RV4CLS (−18.9 ± 3.8 to −23.3 ± 3.6) (all p < 0.001). Greater ΔPVC% correlated with recovery in LV-GLS (Spearman’s rs = −0.51; p = 0.008) and RVFWLS (Spearman’s rs = −0.49; p = 0.010), but not with RV4CLS. Patients achieving a ΔPVC% ≥80% demonstrated greater improvement in LV-GLS and RVFWLS. In exploratory multiple linear regression models, ΔPVC% remained associated with recovery in LV-GLS and RVFWLS, but not with RV4CLS.Conclusions:Catheter ablation of idiopathic RVOT PVCs was associated with significant improvement in biventricular longitudinal strain at 3 months. A higher reduction in PVC burden was associated with greater improvements in LV-GLS and RVFWLS, suggesting that suppression of ectopic burden may be linked to early mechanical recovery. Given the observational pre–post design and modest sample size, these findings should be interpreted as associative and hypothesis-generating.