Outcome of repeat ablation for premature ventricular contractions in patients with prior ablation failure: Impact of advanced techniques

Background

The utility of repeat ablation for premature ventricular contractions (PVCs) after prior ablation failure is not clear.

Objective

The purpose of this study was to assess the outcomes of repeat ablation and the use of different techniques in patients who failed prior PVC ablation.

Methods

We reviewed 239 consecutive patients who underwent PVC ablation. When standard endocardial ablation with normal or half-normal saline failed, we considered an advanced ablation technique. Acute success was defined as abolition of the target PVC. Clinical and procedural findings, PVC origins, and acute and follow-up outcomes were compared in those with and without a prior failed ablation procedure.

Results

Of 239 patients, 75 (31%) had failed a prior ablation procedure, and they more often had left ventricular outflow tract PVCs. Despite failing prior ablation, repeat standard ablation was acutely successful in 59% of patients, and 75% of these patients had long-term success. Acute standard ablation success rate was lower and long-term recurrence rate was higher than in patients without prior ablation (59% vs 95%, P <.001; and 29% vs 17%, P <.05, respectively). Of the 31 repeat standard procedures that again failed, advanced techniques were performed in 23 (16 needle, 5 epicardial, 2 simultaneous ablation) and were acutely successful in 16 (70%) with long-term success in 14 (45%). Overall long-term success for patients with prior failed standard ablation was 71%.

Conclusion

Although success is lower for patients with prior failed ablation, repeat ablation seems reasonable for many, and the use of advanced techniques increased success to 71% in this group.