Abstract 4136869: Time Course and Predictors of PVC Recurrence After Acutely Successful Catheter Ablation

Introduction: In prior studies, predictors of long-term success following acutely successful radiofrequency (RF) ablation have included female-sex, single-PVC morphology and EGM-QRS > 24ms. Time course and predictors of PVC recurrence following acutely successful ablation has been less well documented. Use of extended ambulatory monitoring in the immediate post-procedural period can help to identify those with early recurrence. Goals: To define time to recurrence and predictors of recurrence of PVCs after RF ablation following acutely successful ablation. Methods: Consecutive patients from January 1 st , 2016 through December 31 st , 2023 undergoing PVC ablation with available post-ablation extended ambulatory monitoring (Zio, iRhythm, San Francisco, CA) were retrospectively analyzed. Recurrence was defined as an increase in PVC burden to >5% during monitoring after acute success or failure to have sustained reduction in PVC burden of >80%. Acute success was defined as elimination of the targeted PVC after the last ablation lesion. Long-term succes was defined as absence of targeted PVC's during all follow-up visits and PVC-burden < 5% on follow-up monitoring. Results: Among 121 patients who underwent successful PVC ablation, 101 (83.4%) had long-term success and 20 (17%) had recurrence. Patients with recurrence were older (62.4 ± 12 vs 55 ± 13., p = 0.019), had a higher incidence of CAD (13 (13%) vs 9 (45%), p = 0.001) and CHF (40 (40%) vs 15 (75%), p = 0.004). At time of ablation, the recurrence group was also more likely to have >1 PVC morphology (6 (6%) vs 8 (40%), p = <0.001). Location and earliest activation time of the predominant PVC were not assocated with likelihood of recurrence. Within the recurrence group, 13 (65%) had recurrence in the immediate 2 week post-procedural period with an average time to recurrence of 3.9 days. Conclusion: Recurrence occured in slightly less than 20% of cases with a relatively high proportion of those occuring within the immediate 2 week post-procedural period during extended ambulatory monitoring. The presence of greater than 1 PVC morphology at time of ablation is a risk factor for recurrence suggesting a higher likelihood of acute suppression without durable resolution in those instances.