Cardiology · Medical Literature
Ablation outcomes in PVC-induced cardiomyopathy: A systematic review and meta-analysis stratified by site of origin.
Abstract
Frequent premature ventricular complexes (PVC) can lead to a reversible form of left ventricular (LV) dysfunction termed PVC-induced cardiomyopathy (PIC). Catheter ablation is increasingly recognized as the most effective treatment; however, outcomes may differ by the anatomical site-of-PVC origin. We conducted a systematic review and meta-analysis of studies published from 2000 to 2025 evaluating catheter ablation in patients with PIC. Eligible studies reported outcomes stratified by PVC origin, including right ventricular outflow tract (RVOT), LV outflow tract (LVOT), papillary muscle, and epicardial/para-His regions. Primary outcomes were change in LV ejection fraction (LVEF) and normalization (≥ 50%). Secondary outcomes included PVC recurrence, repeat ablation, and major complications. Pooled estimates were calculated using random-effects models. Twelve studies (n = 718) met inclusion. Overall, ablation improved LVEF by a mean of 11.0% (95% confidence interval 9.5-12.5; P < .001), with normalization in ~65% of patients. Outcomes varied by PVC origin: RVOT (ΔLVEF ~12.5%, normalization ~70%), LVOT (ΔLVEF ~11.0%, normalization ~65%), papillary muscle (ΔLVEF ~8.0%, normalization ~55%), and epicardial/para-His (ΔLVEF ~6.5-7.0%, normalization ~50%). Recurrence rates were lowest for RVOT/LVOT (~12-20%) and highest for papillary and epicardial sites (~28-30%). Major complications were infrequent (~3-5%), but more common with epicardial or para-His ablations. Catheter ablation provides substantial and often reversible improvement in LVEF for patients with PIC, with generally low complication rates. However, outcomes are strongly site-dependent, favoring RVOT and LVOT origins.
Clinical relevance
PVC-induced cardiomyopathy (PIC) represents a reversible yet underrecognized etiology of left ventricular dysfunction, making early identification and intervention critical to prevent irreversible myocardial remodeling. This meta-analysis addresses a key evidence gap by stratifying catheter ablation outcomes according to anatomical PVC site of origin — data essential for individualized procedural risk-benefit counseling. Given the growing utilization of catheter ablation for frequent PVCs, these findings are immediately actionable for electrophysiologists and heart failure specialists managing patients with unexplained LV dysfunction.
Key findings
1. Overall catheter ablation improved LVEF by a mean of 11.0% (95% CI 9.5–12.5%; P < .001) across 12 studies encompassing 718 patients with PIC, using pooled random-effects modeling. 2. LVEF normalization (≥50%) was achieved in approximately 65% of patients overall, confirming the predominantly reversible nature of PIC following successful ablation. 3. RVOT origin conferred the most favorable outcomes: ΔLVEF ~12.5% and normalization rate ~70%, with PVC recurrence of only ~12–20%. 4. LVOT origin yielded intermediate results: ΔLVEF ~11.0% and normalization ~65%, with recurrence similarly low at ~12–20%. 5. Papillary muscle origin was associated with attenuated recovery: ΔLVEF ~8.0%, normalization ~55%, and higher recurrence rates of ~28–30%. 6. Epicardial and para-His origins demonstrated the least favorable profile: ΔLVEF ~6.5–7.0%, normalization ~50%, recurrence ~28–30%, and the highest major complication rates (~3–5% overall, disproportionately concentrated in this subgroup).
Practice implications
Catheter ablation should be strongly considered as first-line therapy for PIC, particularly when PVCs arise from the RVOT or LVOT, given high rates of LVEF normalization (~65–70%) and low recurrence; pre-procedural imaging (cardiac MRI or electroanatomic mapping) to characterize PVC origin should guide patient selection and informed consent regarding expected recovery. For patients with papillary muscle or epicardial/para-His PVC origins, clinicians should counsel for a more guarded prognosis — lower normalization rates (~50–55%), higher recurrence (~28–30%), and elevated procedural risk — and consider referral to high-volume centers with epicardial access expertise. A structured post-ablation follow-up protocol including serial echocardiography at 3 and 6 months is warranted to assess LVEF trajectory, identify non-responders who may require repeat ablation, and determine whether to continue or de-escalate guideline-directed medical therapy for LV dysfunction.