Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes

BACKGROUND Patients with frequent premature ventricular complexes (PVCs) and PVC-induced cardiomyopathy usually have recovery of left ventricular (LV) dysfunction postablation. The time course of recovery of LV function has not been described. OBJECTIVE To describe the time course and predictors of recovery from LV dysfunction after effective ablation of PVCs in patients with PVC-induced cardiomyopathy. METHODS In a consecutive series of 264 patients with frequent idiopathic PVCs referred for PVC ablation, LV dysfunction was present in 87 patients (mean ejection fraction 40% +/- 10%). The PVC burden was reduced to <20% of the initial PVC burden in 75 patients. In these patients, echocardiography was repeated 3-4 months postablation. If LV function did not normalize after 3-4 months, a repeat echocardiogram was performed every 3 months until there was normalization or stabilization of LV function. RESULTS The ejection fraction normalized at a mean of 5 +/- 6 months postablation. The majority of patients (51 of 75, 68%) with PVC-induced LV dysfunction had a recovery of LV function within 4 months. In 24 (32%) patients, recovery of LV function took more than 4 months (mean 12 +/- 9 months; range 5-45 months). An epicardial origin of PVCs was more often present (13 of 24, 54%) in patients with delayed recovery of LV function than in patients with early recovery of LV function (2 of 51, 4%; P < .0001). The PVC-QRS width was significantly longer in patients with delayed recovery than in patients with recovery within 4 months (170 +/- 21 ms vs 159 +/- 16 ms; P = .02). In multivariate analysis, only an epicardial PVC origin was predictive of delayed recovery of LV function in patients with PVC-induced cardiomyopathy. CONCLUSIONS PVC-induced cardiomyopathy resolves within 4 months of successful ablation in most patients. In about one-third of the patients, recovery is delayed and can take up to 45 months. An epicardial origin predicts delayed recovery of LV function.