Catheter Ablation of Premature Ventricular Contractions Originating From Periprosthetic Aortic Valve Regions.

BACKGROUND Little is known about the ablation outcomes of premature ventricular contractions (PVCs) that originate from the periprosthetic aortic valve (PPAV) regions of patients with aortic valve replacement (AVR). METHODS AND RESULTS Our study had 11 patients who underwent catheter ablation for PVCs arising from the PPAV regions (bioprosthetic aortic valve, n=5; mechanical aortic valve, n=6). The PVC characteristics, procedure characteristics, and efficacy of ablation were compared with a control group (n=33). At baseline, the PPAV group had a lower left ventricular ejection fraction (mean [SD], 41% [12%] vs 51% [8%]; P=.002). Rate of acute ablation success was 90.9% in the PPAV group. Ablation sites were identified above left coronary cusp (LCC) and right coronary cusp commissure (LRCC) in 1 PVC, below the prosthetic valve in 8 PVCs (4 below LCC and 4 below LRCC), and within the distal coronary sinus in 2 PVCs. The mean procedure time, fluoroscopy time, and radiation in the PPAV group were all significantly greater than those in the control group (all P<.05). However, the number of radiofrequency ablation energy deliveries was not different. The PPAV group had a long-term success rate comparable with the control group (72.7% vs 87.9%, P=.48) and an increase of left ventricular ejection fraction from 43% to 49% after successful PVC ablation at follow-up (P<.001). Echocardiography showed no significant change in valve regurgitation after ablation. No new atrioventricular block occurred. CONCLUSION PVCs arising from PPAV regions can be successfully ablated in patients with prior AVR, without damaging the prosthetic aortic valve and atrioventricular conduction. This article is protected by copyright. All rights reserved.