Effects of catheter ablation of "asymptomatic" frequent ventricular premature complexes in patients with reduced (<48%) left ventricular ejection fraction

Frequent ventricular premature complexes (VPCs), particularly those without troublesome palpitations, are often regarded as a benign arrhythmia and are not treated other than with reassurance. However, VPCs can contribute to left ventricular (LV) dysfunction in the absence of symptoms. The present study was designed to investigate whether catheter ablation of VPCs can improve LV dysfunction in patients with and without troublesome palpitations. Of 80 consecutive patients who underwent catheter ablation of frequent VPCs, 24 (aged 60 ± 15 years) were found to have a reduced LV ejection fraction at baseline (<48%) and included in the present study. No important procedure-related complications occurred in these patients. During a median follow-up of 8 months, the VPC burden after ablation had decreased from 15 ± 6% to 1 ± 1% (p <0.001), and the left ventricular ejection fraction had increased from 32 ± 15% to 43 ± 14% (p <0.001). Ten patients (42%) had no palpitations before ablation. In the other 14 patients, the palpitations were improved or entirely resolved after ablation. No significant difference was found in the extent of LV ejection fraction improvement after ablation between patients with and without palpitations (+11 ± 12% vs +11 ± 11%, p = 0.941) or between patients with different locations of VPC origin. In conclusion, VPCs might not necessarily be associated with palpitations in many patients with LV dysfunction. Successful ablation of frequent VPCs in these "asymptomatic" patients is associated with an improvement in LV function similar to that observed in "symptomatic" patients.