Improvement in left ventricular ejection fraction after radiofrequency catheter ablation of premature atrial contractions in a 23-year-old man

Premature atrial contraction induced cardiomyopathy: A case report

This case report describes the successful management of a 45-year-old female patient with incessant premature atrial complexes (PACs) leading to left ventricular dysfunction. Despite initial treatment with beta-blockers, the patient's PACs persisted, prompting catheter ablation. Mapping in the left atrium identified the site of earliest atrial activation near the right superior pulmonary vein, and radiofrequency energy successfully terminated the PACs. Follow-up assessments showed the patient remained asymptomatic, with normalized left ventricular function. This case highlights the efficacy of catheter ablation in resolving PAC-induced cardiomyopathy and emphasizes the need for further research in this area.

Mapping and Ablation of Isolated Frequent Symptomatic Premature Atrial Contractions in Patients With Structurally Normal Heart

Background

The present study investigated the safety and efficacy of mapping and ablating isolated premature atrial contractions (PACs) in patients with a structurally normal heart, as well as whether the elimination of PACs by radiofrequency catheter ablation (RFCA) improved symptoms and the quality of life.

Methods

Forty-three consecutive patients with frequent, symptomatic, and drug-refractory PACs, but without atrial tachyarrhythmias (≥5 beats), were enrolled. In all patients, we performed physical, laboratory, and imaging examinations to exclude structural heart disease. The quality of life questionnaire SF-36 before and 3 months after RFCA was performed in each patient.

Results

Twenty-three men and 20 women with an average age of 52.6 ± 17.6 years were finally enrolled. The mean number of PACs was 21,685 ± 9,596 per 24 h, and the mean PACs' burden was 28.9 ± 13.7%. Short runs of tachycardia (<5 atrial beats) were observed in 32 patients (74.4%). All patients underwent successful RFCA without complications. The activation time at the successful ablation sites preceded the onset of the P-wave by 36 ± 7.6 ms. During 15 ± 8 months of follow-up, the recurrence of PACs was observed in 2 patients. The 24-h PAC burden was significantly reduced 3 months after RFCA (mean 0.5%, p < 0.05). The quality of life scores were significantly increased 3 months after RFCA (all p < 0.05).

Conclusions

RFCA was feasible, safe, and effective to eliminate isolated frequent, symptomatic, and drug-refractory PACs in patients with a structurally normal heart. The elimination of PACs by RFCA significantly improved symptoms and the quality of life.

Relatively Benign yet a Reversible Cause of Dilated Cardiomyopathy

Arrhythmia-induced cardiomyopathy secondary to frequent ventricular premature contractions is a well-studied phenomenon; however, there is a paucity of data showing a similar association with frequent atrial premature contractions (APCs). Early recognition and successful APC ablation can reverse left ventricular dysfunction in these patients. (Level of Difficulty: Beginner.).

Mapping strategies and ablation of premature atrial complexes

Premature atrial complexes (PACs) are a common finding in patients with structural heart disease, as well as in healthy subjects. In addition to the clinical spectrum ranging from asymptomatic patients to irritating palpitations, PACs are suggested to be associated with an increased risk of atrial fibrillation and stroke. Medical treatment leads to a significant reduction in PACs with clear symptom relief in a large proportion of patients, but is limited in cases of PACs that are refractory to antiarrhythmic drug (AAD) treatment. Furthermore, proarrhythmic effects of AAD or the patient's refusal of AAD treatment due to side effects need to be considered. Ablation of PACs is a good alternative to medical therapy with a comparable safety profile and at least comparable efficacy. In recent years, ultra-high-density (UHD) mapping with multiple improvements for successful ablation has been evolving. Before the introduction of UHD mapping, ablation strategies included activation mapping with single-tip catheters or conventional mapping aiming for the earliest activation of the PAC locally, with the earliest activation suspected to be the origin of the PAC and targeted by radiofrequency (RF) ablation. Using UHD mapping, a three-dimensional local activation map of the atrium can be acquired, identifying the point of earliest activation within the high-resolution map. PAC ablation has therefore developed into a true alternative for the treatment of symptomatic PACs.