Premature Ventricular Contractions and Ultra-High-Definition Mapping. Contribution and Limits.

Background: The utility of ultra-high definition mapping (UHDM) for ablation of premature ventricular contractions (PVC) remains undetermined. The aim of this study was to investigate UHDM for PVC ablation, and additionally to compare to conventional technique.

Methods: Twenty patients investigated using UHDM were prospectively included and analyzed. Electrophysiological caracteristics and results were compared to 40 patients ablated using fluoroscopy only.

Results: 2541±2033 EGMs and 331±240 PVC beats were recorded for each patient. Surfaces of isochronal activations were 2.3±1.7 and 6.9±6.1 cm² (first 10 and 20 ms). Local scar was present in 40% and local block in 65%. Areas of pace-mapping > 95, 90 and 85% concordance were 1.5±3.4, 2.1±3.9 and 3.3±5 cm². Mean distance between the ablation site and the site of best pace-mapping or of earliest activation was 8±8 mm and 5±7 mm. Pre-potential was noted in 17% vs 26% controls (ns). QS pattern was present in 83% vs 83% controls (ns), and earliest activation was - 31±50 vs - 25±14 ms in controls (ns). Procedure (100±36 vs 190±51 min, p< 0.0001) and fluoroscopy duration (15±9 vs 24±9 min, p=0.005) were shorter in controls. Acute success was achieved in 65% patients with UHDM and in 72% controls (p=ns) with lower residual PVC burden in the control group. Over a follow-up of 19±12 months, long-term success was similar between groups (65 vs 68%).

Conclusions: UHDM may reveal poorly recognized activation features and PVC mechanism. In this series, conventional mapping was quicker and did clinically as well as UHDM.