Single catheter approach for treatment of premature ventricular contractions

BackgroundCatheter ablation has become one of the main treatment strategies in patients with premature ventricular complexes (PVC). The successful mapping and ablation can be performed with an ablation catheter without additional diagnostic catheters.HypothesisWe hypothesize that using a single catheter for PVC ablation may decrease complications, procedure time, and fluoroscopy exposure while maintaining comparable success rates.MethodsSixty-nine consecutive patients with PVC were treated with a single catheter approach compared to a historical cohort, in which a conventional setup was used. Propensity score matching was conducted with a 1:1 ratio. Outcome parameters included acute procedural success with elimination of all premature ventricular contractions after catheter ablation, procedural data as well as complication rates.ResultsPatients treated with a single catheter approach had shorter total procedure (60 minutes [IQR: 47,5-69,0 minutes] vs. 90 minutes [IQR 60-120 minutes]; p = 0.001) and fluoroscopy times (218 seconds [IQR: 110,5-446 seconds] vs. 310 seconds [IQR 190-640 seconds]; p = 0.012), which consecutively leads to a reduction of radiation exposure signified by a lower dose area product (155 cGycm(2) [IQR 74.4-334.5 cGycm(2)] vs. 368.4 cGycm(2) [IQR: 126-905.4 cGycm(2)]; p value 0.009). Acute procedural success rates were comparable in both groups (54 [84.3%] in the single catheter approach group and 58 [90.6%] in the conventional group; p: 0.287).ConclusionA single catheter approach for the treatment of PVC is associated with a reduction of procedure- and fluoroscopy time, as well as a lesser radiation exposure, while maintaining equivalent acute success and complication rates compared with a conventionally used catheter setup. In our study, a total of 309 patients were initially treated for PVC ablation from January 2020 to February 2021. Following propensity score matching for a balanced comparison with a historical cohort (2016-2020), the final analysis included 128 patients, with 64 in each group. The investigation into the single catheter approach revealed a 33% reduction in procedure time, with a median of 60 minutes [IQR: 47.5-69.0 minutes] compared with 90 minutes [IQR 60-120 minutes] in the conventional group (p = 0.001). Acute success rates were comparable between groups, with 84.3% in the single catheter approach and 90.6% in the conventional group (p = 0.287). Additionally, a substantial 58% decrease in dose area product was observed in the single catheter approach, with a median of 155 cGycm(2) [IQR 74.4-334.5 cGycm(2)] compared with 368.4 cGycm(2) [IQR: 126-905.4 cGycm(2)] in the conventional group (p = 0.009). These outcomes underscore the procedural efficiency of the single catheter approach, marking a notable advancement in PVC ablation methodologies. image