First-line catheter ablation reduces PVC burden in paediatric population

The use of catheter ablation as first-line treatment reduces the number of premature ventricular complexes (PVCs) in a paediatric population, according to a study presented at EHRA 2019.

This study involved 124 paediatric patients (mean age 12 years) with symptomatic, frequent PVCs who were randomized to receive either catheter ablation (n=62) or medical therapy (n=62), with anti-arrhythmic drugs such as metoprolol 12–25 mg (n=57) or verapamil 20–160 mg (n=5). Freedom from PVCs (rate of ≤300 beats/day based on a 24-hour ECG* Holter monitoring) at 12 months was the study’s primary outcome. Patients were followed up at 1, 3, 6, and 12 months. [EHRA 2019, abstract 847]

At 12 months of follow-up, patients who underwent catheter ablation achieved a significantly higher rate of freedom from PVCs than those who had medical therapy (77.4 percent vs 48.4 percent; p=0.001), with a 62 percent significant reduction in the incidence of PVC (hazard ratio, 0.38; p=0.002).

Patients in the catheter ablation group also had a significantly lower number of PVCs (2,853 vs 11,591; p<0.001) and incidence of PVC burden (2.6 percent vs 10.4 percent; p<0.001) than those in the medical therapy group.

Researchers found that catheter ablation was associated with a 3 percent increase in the left ventricular ejection fraction compared with the medical therapy at 12 months (70.6 percent vs 67.6 percent; p<0.001), “which can potentially prevent left ventricular dysfunction,” said study lead author Dr Alexander Romanov from E. Meshalkin National Medical Research Center in Novosibirsk, Russia.

One patient developed a groin haematoma after the catheter ablation procedure, but this was resolved before discharged.

Fatigue, dizziness, shortness of breath during exercise, and palpitations were the most common reported symptoms of PVCs, with no serious adverse events.

“Catheter ablation of frequent PVCs in paediatric population is safe and effective and is [also] associated with significant PVCs burden reduction over medical therapy,” Romanov said.

“Catheter ablation of frequent, symptomatic PVCs in paediatric population as a first-line therapy is superior over medical therapy for preventing PVCs recurrence and burden without serious procedural complications,” he added.

*ECG: Electrocardiogram