Catheter Ablation vs Antiarrhythmic Drug Therapy for Treatment of Premature Ventricular Complexes: A Systematic Review

Kasun De Silva; Haris Haqqani; Rajiv Mahajan; Pierre Qian; William Chik; Aleksandr Voskoboinik; Peter M Kistler; Geoffrey Lee; Nicholas Jackson; Saurabh Kumar

doi:10.1016/j.jacep.2023.01.035

Catheter Ablation vs Antiarrhythmic Drug Therapy for Treatment of Premature Ventricular Complexes: A Systematic Review

JACC Clin Electrophysiol. 2023 Jun;9(6):873-885. doi: 10.1016/j.jacep.2023.01.035. Epub 2023 Mar 22.

Authors

Affiliations

¹ Department of Cardiology, Westmead Hospital, New South Wales, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia.
² Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
³ University of Adelaide Precinct, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
⁴ Department of Cardiology, Westmead Hospital, New South Wales, Australia.
⁵ Baker Heart and Diabetes Research Institute, Alfred Hospital Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia.
⁶ Baker Heart and Diabetes Research Institute, Alfred Hospital Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia.
⁷ Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁸ Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia.
⁹ Department of Cardiology, Westmead Hospital, New South Wales, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia. Electronic address: Saurabh.kumar@sydney.edu.au.

PMID: 37380322
DOI: 10.1016/j.jacep.2023.01.035

Abstract

There is variability in treatment modalities for premature ventricular complexes (PVCs), including use of antiarrhythmic drug (AAD) therapy or catheter ablation (CA). This study reviewed evidence comparing CA vs AADs for the treatment of PVCs. A systematic review was performed from the Medline, Embase, and Cochrane Library databases, as well as the Australian and New Zealand Clinical Trials Registry, U.S. National Library of Medicine ClinicalTrials database, and the European Union Clinical Trials Register. Five studies (1 randomized controlled trial) enrolling 1,113 patients (57.9% female) were analyzed. Four of five studies recruited mainly patients with outflow tract PVCs. There was significant heterogeneity in AAD choice. Electroanatomic mapping was used in 3 of 5 studies. No studies documented intracardiac echocardiography or contact force-sensing catheter use. Acute procedural endpoints varied (2 of 5 targeted elimination of all PVCs). All studies had significant potential for bias. CA seemed superior to AADs for PVC recurrence, frequency, and burden. One study reported long-term symptoms (CA superior). Quality of life or cost-effectiveness was not reported. Complication and adverse event rates were 0% to 5.6% for CA and 9.5% to 21% for AADs. Future randomized controlled trials will assess CA vs AADs for patients with PVCs without structural heart disease (ECTOPIA [Elimination of Ventricular Premature Beats with Catheter Ablation versus Optimal Antiarrhythmic Drug Treatment]), with impaired LVEF (PAPS [Prospective Assessment of Premature Ventricular Contractions Suppression in Cardiomyopathy] Pilot), and with structural heart disease (CAT-PVC [Catheter Ablation Versus Amiodarone for Therapy of Premature Ventricular Contractions in Patients With Structural Heart Disease]). In conclusion, CA seems to reduce recurrence, burden, and frequency of PVCs compared with AADs. There is a lack of data on patient- and health care-specific outcomes such as symptoms, quality of life, and cost-effectiveness. Several upcoming trials will offer important insights for management of PVCs.

Keywords: antiarrhythmic drug; catheter ablation; premature ventricular complex; ventricular arrhythmia; ventricular ectopy.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Arrhythmia Agents / therapeutic use
Australia
Catheter Ablation*
Female
Heart Diseases*
Humans
Male
Prospective Studies
Quality of Life
United States
Ventricular Premature Complexes* / therapy

Substances

Anti-Arrhythmia Agents