Association of Anatomical Localization with Early Recurrence After Premature Ventricular Contraction Ablation

Abstract

To evaluate the association of anatomical localization with early recurrence during 24-hour telemetry among patients achieving acute electrophysiology laboratory (EP-lab) success, and secondarily with acute EP-lab outcome and target PVC detection in the overall cohort. This retrospective single-center study included 357 patients undergoing radiofrequency PVC ablation. Acute EP-lab success was assessed after provocation and 30-minute observation. Target PVC detection during 24-hour telemetry was evaluated in the overall cohort. Early recurrence was defined as target-morphology PVC reappearance during telemetry only after acute EP-lab success. Multivariable logistic regression assessed factors associated with acute success and absence of target PVCs during telemetry; localization-specific early recurrence was compared in the acute-success subgroup. Acute EP-lab success was achieved in 252 patients (70.6%). Target PVCs were detected during telemetry in 152 patients (42.6%): 105 with ongoing acute EP-lab failure and 47 with early recurrence after acute success. Among acute-success patients, early recurrence varied by localization (Fisher-Freeman-Halton exact p = 0.002) and was more frequent for left- than right-sided origins (27.2% vs. 8.6%, p < 0.001). Localization remained associated with the whole-cohort telemetry outcome after adjustment for age and sex. In the acute-success model, LVOT and fascicular origins did not differ from RVOT origin, whereas other non-RVOT locations had lower odds of acute success. Anatomical localization was associated with acute EP-lab outcome and 24-hour target PVC detection. Early recurrence also differed by localization after acute success. These findings reflect very early in-hospital outcomes and require validation against long-term clinical and Holter-based follow-up.