Catheter Ablation vs Antiarrhythmic Drug Therapy for Treatment of Premature Ventricular Complexes: A Systematic Review.

There is variability in treatment modalities for premature ventricular complexes (PVCs), including use of antiarrhythmic drug (AAD) therapy or catheter ablation (CA). This study reviewed evidence comparing CA vs AADs for the treatment of PVCs. A systematic review was performed from the Medline, Embase, and Cochrane Library databases, as well as the Australian and New Zealand Clinical Trials Registry, U.S. National Library of Medicine ClinicalTrials database, and the European Union Clinical Trials Register. Five studies (1 randomized controlled trial) enrolling 1,113 patients (57.9% female) were analyzed. Four of five studies recruited mainly patients with outflow tract PVCs. There was significant heterogeneity in AAD choice. Electroanatomic mapping was used in 3 of 5 studies. No studies documented intracardiac echocardiography or contact force-sensing catheter use. Acute procedural endpoints varied (2 of 5 targeted elimination of all PVCs). All studies had significant potential for bias. CA seemed superior to AADs for PVC recurrence, frequency, and burden. One study reported long-term symptoms (CA superior). Quality of life or cost-effectiveness was not reported. Complication and adverse event rates were 0% to 5.6% for CA and 9.5% to 21% for AADs. Future randomized controlled trials will assess CA vs AADs for patients with PVCs without structural heart disease (ECTOPIA [Elimination of Ventricular Premature Beats with Catheter Ablation versus Optimal Antiarrhythmic Drug Treatment]), with impaired LVEF (PAPS [Prospective Assessment of Premature Ventricular Contractions Suppression in Cardiomyopathy] Pilot), and with structural heart disease (CAT-PVC [Catheter Ablation Versus Amiodarone for Therapy of Premature Ventricular Contractions in Patients With Structural Heart Disease]). In conclusion, CA seems to reduce recurrence, burden, and frequency of PVCs compared with AADs. There is a lack of data on patient- and health care-specific outcomes such as symptoms, quality of life, and cost-effectiveness. Several upcoming trials will offer important insights for management of PVCs.

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Funding Support and Author Disclosures Dr Kumar was supported in part from the NSW Early-Mid Career Fellowship; and has received research grants from Abbott Medical and Biotronik; and honoraria from Biosense Webster, Abbott Medical, Biotronik, and Sanofi Aventis. Dr De Silva is supported by a postgraduate research scholarship from the National Health and Medical Research Council of Australia. Dr Mahajan is supported by The Hospital Research Foundation Mid-Career Fellowship. Dr Qian was supported by an NSW Early-Mid Career Fellowship and Heart Foundation Postdoctoral Fellowship (105197).Mr Campbell has received speaker honoraria from Biosense Webster in the last 12 months. Dr Mahajan has served on the advisory board of Abbott and Medtronic. The University of Adelaide reports receiving on behalf of Dr Mahajan lecture and/or consulting fees from Abbott, Bayer, Biotronik, Medtronic, and Pfizer and research funding from Abbott, Bayer, and Medtronic. Dr Haqqani has received speaker honoraria from Boston Scientific and Abbott. Dr Lee has received consulting fees from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.