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Additional Lesion Sets in Ablation of Outflow Tract Premature Ventricular Contractions: A Randomized Clinical Trial.
JAMA Cardiology ( IF 14.8 ) Pub Date : 2024-11-01 , DOI: 10.1001/jamacardio.2024.2975 Kexin Wang,Fu Yi,Fangyi Xiao,Cao Zou,Yuzhen Zhang,Yuegang Wang,Linsheng Shi,Chengzong Li,Long Chen,Shuanglun Xie,Wenzhi Shen,Ning Zhang,Qiang Wu,Qiang Xu,Yuan Ji,Cheng Wang,Zhiyu Lin,Youquan Wei,Zhongbao Ruan,Yumin Sun,Weizhu Ju,Minglong Chen,
JAMA Cardiology ( IF 14.8 ) Pub Date : 2024-11-01 , DOI: 10.1001/jamacardio.2024.2975 Kexin Wang,Fu Yi,Fangyi Xiao,Cao Zou,Yuzhen Zhang,Yuegang Wang,Linsheng Shi,Chengzong Li,Long Chen,Shuanglun Xie,Wenzhi Shen,Ning Zhang,Qiang Wu,Qiang Xu,Yuan Ji,Cheng Wang,Zhiyu Lin,Youquan Wei,Zhongbao Ruan,Yumin Sun,Weizhu Ju,Minglong Chen,
Importance
Recurrence remains a challenge after ablation of outflow tract premature ventricular contractions (OT-PVCs). Although adding additional lesions next to the index effective ablation site is sometimes performed to reinforce the ablation, it remains uncertain whether this approach is effective.
Objective
To test the hypothesis that additional ablation lesions would reduce the recurrence rate compared with single-point ablation at the index effective site for the ablation of OT-PVCs.
Design, Setting, and Participants
This study was a multicenter, prospective, randomized clinical trial. Patients receiving their first catheter ablation for OT-PVCs were enrolled from 18 hospitals in China between October 2021 and February 2023. Scheduled follow-up duration was 3 months after the procedure.
Intervention
After identifying the target point and eliminating the PVC by a single-point ablation, patients were randomized 1:1 into an additional ablation group or a control group.
Main Outcomes and Measures
The primary end point of the study was freedom from PVC recurrence (≥80% reduction of PVC burden, which is the number of PVCs in 24 hours/total heartbeats in 24 hours × 100%) from baseline to 3 months postprocedure.
Results
Of 308 patients enrolled in the study, 286 (mean [SD] age, 49.2 [14.6] years; 173 female [60.5%]) were randomized to the additional ablation or the control group. The additional ablation group had a mean (SD) of 6.3 (1.1) radiofrequency applications, whereas the control group (single-point ablation group) had a mean (SD) of 1 (0) radiofrequency application. After a median (IQR) follow-up of 3.2 (0) months, the rate of freedom from PVCs was significantly higher in the additional ablation group (139 of 142 [97.9%]) compared with the control group (115 of 139 [82.7%]; P < .001). Patients in the additional ablation group also had a more substantial reduction in PVC burden than the control group (mean [SD] reduction, 23.0% [10.5%] vs 19.0% [10.4%]; P = .002). There were no severe periprocedural complications in either group.
Conclusions and Relevance
This randomized clinical trial showed a benefit of additional ablation in reducing the recurrence of OT-PVCs compared with the single-point ablation strategy, without increased complication risk. Additional ablations surrounding the index effective ablation point should be considered in OT-PVC ablation.
Trial Registration
Chinese Clinical Trials Registry Identifier: ChiCTR2200055340.
更新日期：2024-09-25
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