Benign symptomatic premature ventricular complexes: short- and long-term efficacy of antiarrhythmic drugs and radiofrequency ablation.

BACKGROUND: There is little data on the long-term efficacy of antiarrhythmic drugs (AADs) and radiofrequency catheter ablation (RFCA) in patients with symptomatic premature ventricular complexes (PVCs) and no organic heart disease.

AIM: To evaluate the short- and long-term efficacy and tolerance of AAD therapy and RFCA in patients with idiopathic PVCs.

METHODS: This was a prospective, crossover, open-label study performed in 84 consecutive patients (mean age 47 ± 15 years; 60% women) with symptomatic idiopathic PVCs (mean PVCs/24 h, 13,768 ± 9,424; range 1,693-42,687). Patients were treated for 2-3 weeks with metoprolol, propafenone or verapamil. Then patients were referred for RFCA, if they had drug intolerance, inefficacy or did not wish to have prolonged AAD treatment.

RESULTS: The most efficacious agent was propafenone, followed by verapamil, and then metoprolol [35 (42%), 13 (15%) and eight (10%) responders, respectively, p < 0.01 vs propafenone]. Only responders to drug treatment had a significant reduction in symptom severity (Visual Analogue Scale score: 6.2 ± 1.4 vs 2.7 ± 2.0, p < 0.001). After AAD, 50 (60%) patients underwent RFCA. During long-term follow-up (48 ± 10 months), RFCA (mean 1.2 procedures/patient) was effective in 44/50 (88%) patients. Of the 34 remaining patients, 21 remained on effective AAD, 6 patients remained on ineffective AAD, and 7 patients were taken off AADs therapy due to spontaneous remission of PVCs or a decrease in symptom severity. conclusions: Short-term treatment with propafenone was more effective than verapamil or metoprolol in suppressing idiopathic PVCs. However, optimal benefit was achieved with RFCA, which was effective and safe during long-term follow-up.