Post-Extrasystolic Potentiation as a Predictor of Recovery of Left Ventricular Dysfunction After Radiofrequency Catheter Ablation.

ABSTRACT

OBJECTIVES: This study hypothesizes that post-extrasystolic potentiation reflects left ventricle contractile reserve and therefore may predict an improvement of premature ventricular contraction (PVC)-induced cardiomyopathy after PVC ablation. BACKGROUND: Post-extrasystolic potentiation is a physiologic phenomenon of blood pressure accentuation after a PVC beat. METHODS: We performed a retrospective study of patients with a PVC burden of ≥10% PVC/24 h and left ventricular ejection fraction (LVEF) of <50% who underwent successful ablation between January 1, 2009, to June 30, 2015. Subjects were classified as having reversible (a final LVEF ≥50%) or irreversible (final LVEF <50%) LV dysfunction on a follow-up echocardiogram. A reference (control) group with ≥10% PVC but normal LV function was also identified. RESULTS: Sixty-one patients (age 68 ± 11 years, 98% male) were studied 30 with preserved and 31 with reduced LVEF. During median follow-up of 9.4 months, the LVEF of 17 of 31 reduced EF patients improved (reversible) but 14 did not (irreversible). The post-PVC beat systolic blood pressure (SBP) (mm Hg) increase ranged from 12.1 in control subjects (LVEF >50%) to 11.5 in reversible patients to 5 in irreversible patients. In multivariate analysis, the independent predictors of reversible LV function were post-PVC SBP rise (odds ratio [OR] 4.61; 95% confidence interval [CI] 1.45 to 15.83 per 5-mm Hg increase; p < 0.001), post-PVC pulse pressure change (OR 5.2; 95% CI 2.3 to 18.6 per 5-mm Hg increase; p < 0.001), and PVC QRS duration (OR 2.78; 95% CI 1.63 to 10.94 per 10-ms increase; p < 0.001). CONCLUSIONS: In patients with LV dysfunction and frequent PVC, post-PVC SBP accentuation may be a marker for subsequent recovery of LVEF after ablation in presumed PVC-induced cardiomyopathy.