Iranian Heart Journal

Iranian Heart Journal

Electrocardiographic and Demographic Characteristics of Premature Ventricular Contractions With Unsuccessful Ablation

Document Type : Original Article

Authors
Mohammad javad Aminizadeh 1
Samira Esfandiari Mehni 1
Ali Daryanavard 1
Roya Rezai 1
Ali Asghari 1
Seyed Saeed Dadgar 1
Sadaf Fani-Hanifeh 1
Hooman Bakhshandeh 2
Shabnam Madadi 3
1 Rajaie Cardiovascular Medical and Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
2 Cardiovascular Epidemiology Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, IR Iran.
3 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical, and Research Institute, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Premature ventricular contractions (PVCs) are the most common arrhythmia observed in ECGs. Analyzing PVC patterns in ECGs aids in identifying types with a higher likelihood of unsuccessful ablation. This study aimed to investigate the ECG and demographic characteristics of these PVCs.
 
Methods: This study included all patients with PVCs who were hospitalized and underwent unsuccessful ablation at the Rajaie Cardiovascular Medical and Research Institute between 2017 and 2022. ECG results were compared, and PVC patterns in different types were identified.
 
Results: The study comprised 80 patients, ranging from 17 to 79 years of age, with a male predominance of 63% and a female representation of 37%. The most frequently observed locations for PVCs were the left ventricular summit (n =27 [34%]), the right ventricular outflow tract (n =13 [9.3%]), papillary muscles (n = 7 [9%]), the great cardiac vein (n =6 [8%]), the mitral and tricuspid annulus (n = 5 [6%]), the aortomitral continuity (n =3 [4%]), the fascicle (n = 3 [4%]), and the mid-myocardial part (n = 3 [4%]). Almost all patients (96.3%) experienced symptoms, and the average ejection fraction was 39.2%. Regarding transition location, 50% occurred in lead V3 (the gray zone). Additionally, 32.5% of the patients demonstrated late transition, 3% showed early transition, and the remaining subjects exhibited positive concordance. Another parameter, breakthrough, was observed in 56% of patients.
 
Conclusions: In this study, the left ventricular summit was identified as the most common site for unsuccessful PVC ablation. This finding highlights the importance of precise electroanatomic mapping during the ablation process. Furthermore, a notable pattern observed in cases of unsuccessful PVC ablation was the breakthrough pattern, suggesting that this pattern could serve as a potential predictor for the success of the ablation procedure. (Iranian Heart Journal 2025; 26(1): 27-34)
Keywords
Ventricular tachycardia
PVC
Unsuccessful ablation
Electrocardiographic
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Iranian Heart Journal
Volume 26, Issue 1
Winter 2025
Pages 27-34