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: 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%) patients had failed a prior ablation procedure and they more often had LVOT 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 compared to patients without prior ablation (59% vs 95%; P<0.001, 29% vs 17%; P<0.05, respectively). Of the 31 repeat standard procedures that again failed, advanced techniques were performed in 23 (16 Needle, 5 epicardial and 2 simultaneous ablation), and were acutely successful in 16 (70%) with long-term success in 14 (45%). Over all 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 appears reasonable for many and the use of advanced techniques increased success to 71% in this group.