Clinical and electrocardiographic predictors of outflow tract premature ventricular complexes ablation success

Abstract

Aim. Premature ventricular complexes (PVC) are a common form of arrhythmia. Clinical and electrocardiographic (ECG) characteristics associated with PVC ablation failure are poorly understood. Therefore, the current study aimed to study these characteristics, which might be linked to ineffective ablation. Methods. A total of 60 patients with documented idiopathic outflow PVCs underwent radiofrequency catheter ablation (RFCA). Patients’ symptoms were assessed using the Arrhythmia-Specific Tachycardia and Arrhythmia (ASTA) questionnaire. Baseline ECG was performed to identify ECG criteria potentially associated with recurrence. A follow-up was conducted 6 months later using 24hr Holter monitoring. Results. Our study included 60 consecutive patients, with a mean age of 44.3 years (SD=14.1), of which 56.7% were females. Successful ablation was achieved in 44 patients. We found that larger R-wave amplitudes in V1 (p=0.002), larger R/S ratio in V2 (p=0.002), and a higher pre-ablation ASTA score (p<0.001) were significant predictors of unsuccessful ablation. Using ROC curve analysis, ASTA score demonstrated high sensitivity (81.25%) but moderate specificity (68.18%) at a cut point of 9. The R-wave amplitude in lead V1 shows high sensitivity (93.75%) but poor specificity (45.45%) at a cut point of 0.2 mV. When we combined the three predictors, we reached a sensitivity 97.7% and a specificity 81.3% (p < 0.001). Conclusion . Certain clinical and ECG criteria - specifically, the pre-ablation ASTA score, R-wave amplitudes in lead V1, and R/S ratio in lead V2 - can help predict the success rate of outflow PVC ablation. This could guide the development of a more effective ablation technique and assist in preoperative patient counseling.