Catheter ablation of epicardial premature ventricular complexes in patients with and without cardiac scar
- 1Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, USA
Abstract
Background: The left ventricular epicardium is a common site of origin (SOO) among patients with idiopathic premature ventricular complexes (PVCs) undergoing catheter ablation procedures. Less is known about epicardial PVC ablation among patients with myocardial scarring. The objective of this paper is to report on the presence and impact of cardiac scar among patients with epicardial PVCs undergoing ablation procedures.
Methods: In a retrospective analysis, patients with epicardial PVCs and late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) imaging were included. Acute and long-term procedural outcomes were examined and stratified by the presence or absence of cardiac scar.
Results: Twenty-nine patients were included (male 17/29(59%), age 55±14 years, ejection fraction 48±12%, PVC burden 25±12%, ischemic cardiomyopathy (CM) n = 3, non-ischemic CM n = 7, PVC induced CM n = 5). The SOO was left ventricular summit (n = 20), great cardiac vein (n = 2), cardiac crux (n = 4), or basal anterolateral epicardium (n = 3). Ablation within the CVS was limited by proximity to the coronary arteries (n = 16), inaccessibility of ablation catheter (n = 5), or elevated baseline impedance (n = 2). LGE-CMR scar was present at the arrhythmia SOO in 14/29(48%) patients. There were no differences in procedural, radiofrequency, or fluoroscopy times between patients with and without scar (p > 0.05). Ablation was successful in 14/29 patients and partially successful in 8/29 patients; the post-ablation PVC burden was 8±10% with no differences among those with or without cardiac scar (P > 0.05).
Conclusion: Epicardial PVCs may be encountered in patients with and without structural heart disease, with LGE-CMR located at the PVC SOO in almost half of the patients. While LGE-CMR remains a powerful diagnostic modality, its utility in predicting procedural outcomes for epicardial PVC ablation may be limited.
Summary: Among consecutive patients undergoing ablation of premature ventricular complexes with an epicardial origin, LGE-CMR defined scar was present at the site of origin in approximately 50% of patients.
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BibTeX
@article{jiwani2026catheter,
title = {{Catheter ablation of epicardial premature ventricular complexes in patients with and without cardiac scar}},
author = {Sania Jiwani and Kelly Arps and Muazzum Shah and Amrish Deshmukh and Jackson J. Liang and Rakesh Latchamsetty and Thomas Crawford and Krit Jongnarangsin and Hakan Oral and Fred Morady and Frank Bogun and Michael Ghannam},
journal = {Journal of Interventional Cardiac Electrophysiology},
year = {2026},
month = may,
doi = {10.1007/s10840-026-02351-5},
url = {https://doi.org/10.1007/s10840-026-02351-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Catheter ablation of epicardial premature ventricular complexes in patients with and without cardiac scar
AU - Sania Jiwani
AU - Kelly Arps
AU - Muazzum Shah
AU - Amrish Deshmukh
AU - Jackson J. Liang
AU - Rakesh Latchamsetty
AU - Thomas Crawford
AU - Krit Jongnarangsin
AU - Hakan Oral
AU - Fred Morady
AU - Frank Bogun
AU - Michael Ghannam
PY - 2026
DA - 2026/05/23
JO - Journal of Interventional Cardiac Electrophysiology
DO - 10.1007/s10840-026-02351-5
UR - https://doi.org/10.1007/s10840-026-02351-5
AB - Background: The left ventricular epicardium is a common site of origin (SOO) among patients with idiopathic premature ventricular complexes (PVCs) undergoing catheter ablation procedures. Less is known about epicardial PVC ablation among patients with myocardial scarring. The objective of this paper is to report on the presence and impact of cardiac scar among patients with epicardial PVCs undergoing ablation procedures. Methods: In a retrospective analysis, patients with epicardial PVCs and late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) imaging were included. Acute and long-term procedural outcomes were examined and stratified by the presence or absence of cardiac scar. Results: Twenty-nine patients were included (male 17/29(59%), age 55±14 years, ejection fraction 48±12%, PVC burden 25±12%, ischemic cardiomyopathy (CM) n = 3, non-ischemic CM n = 7, PVC induced CM n = 5). The SOO was left ventricular summit (n = 20), great cardiac vein (n = 2), cardiac crux (n = 4), or basal anterolateral epicardium (n = 3). Ablation within the CVS was limited by proximity to the coronary arteries (n = 16), inaccessibility of ablation catheter (n = 5), or elevated baseline impedance (n = 2). LGE-CMR scar was present at the arrhythmia SOO in 14/29(48%) patients. There were no differences in procedural, radiofrequency, or fluoroscopy times between patients with and without scar (p > 0.05). Ablation was successful in 14/29 patients and partially successful in 8/29 patients; the post-ablation PVC burden was 8±10% with no differences among those with or without cardiac scar (P > 0.05). Conclusion: Epicardial PVCs may be encountered in patients with and without structural heart disease, with LGE-CMR located at the PVC SOO in almost half of the patients. While LGE-CMR remains a powerful diagnostic modality, its utility in predicting procedural outcomes for epicardial PVC ablation may be limited. Summary: Among consecutive patients undergoing ablation of premature ventricular complexes with an epicardial origin, LGE-CMR defined scar was present at the site of origin in approximately 50% of patients.
SN - 1383-875X
SN - 1572-8595
ER -