Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes.

BACKGROUND: Patients with frequent premature ventricular complexes (PVCs) and PVC-induced cardiomyopathy usually have recovery of left ventricular (LV) dysfunction postablation. The time course of recovery of LV function has not been described.

OBJECTIVE: To describe the time course and predictors of recovery from LV dysfunction after effective ablation of PVCs in patients with PVC-induced cardiomyopathy.

METHODS: In a consecutive series of 264 patients with frequent idiopathic PVCs referred for PVC ablation, LV dysfunction was present in 87 patients (mean ejection fraction 40%±10%). The PVC burden was reduced to<20% of the initial PVC burden in 75 patients. In these patients, echocardiography was repeated 3-4 months postablation. If LV function did not normalize after 3-4 months, a repeat echocardiogram was performed every 3 months until there was normalization or stabilization of LV function.

RESULTS: The ejection fraction normalized at a mean of 5±6 months postablation. The majority of patients (51 of 75, 68%) with PVC-induced LV dysfunction had a recovery of LV function within 4 months. In 24 (32%) patients, recovery of LV function took more than 4 months (mean 12±9 months; range 5-45 months). An epicardial origin of PVCs was more often present (13 of 24, 54%) in patients with delayed recovery of LV function than in patients with early recovery of LV function (2 of 51, 4%; P<.0001). The PVC-QRS width was significantly longer in patients with delayed recovery than in patients with recovery within 4 months (170±21 ms vs 159±16 ms; P = .02). In multivariate analysis, only an epicardial PVC origin was predictive of delayed recovery of LV function in patients with PVC-induced cardiomyopathy.

CONCLUSIONS: PVC-induced cardiomyopathy resolves within 4 months of successful ablation in most patients. In about one-third of the patients, recovery is delayed and can take up to 45 months. An epicardial origin predicts delayed recovery of LV function.