{"doi":"10.1016/j.hroo.2021.02.003","title":"Empiric catheter ablation of premature ventricular contractions when there is a &gt;20% burden in an asymptomatic patient with normal left ventricular size and function—An argument for a conservative, do-less approach","abstract":"Key Findings▪Minimally and asymptomatic patients with frequent premature ventricular contractions (PVCs) and normal left ventricle (LV) size and function have a significant rate of spontaneous resolution without treatment (up to 44%).▪The rate to overall progression to LV dysfunction (LV ejection fraction <50%) appears to be low at approximately 4%–5%; and of those patients who exhibit a reduction in LV ejection fraction <50%, most are asymptomatic, without signs or symptoms of clinical heart failure or cardiomyopathy.▪Although success rates are high for catheter ablation and complication rates are low, no treatment approach has zero risk, and any complication in asymptomatic patients, the overwhelming majority (≈95%) of whom will not progress to any clinical cardiomyopathy or will even resolve spontaneously, is tragic.▪A conservative approach with clinical surveillance without offering catheter ablation in asymptomatic patients with PVCs and normal LV size and function should be preferred. ▪Minimally and asymptomatic patients with frequent premature ventricular contractions (PVCs) and normal left ventricle (LV) size and function have a significant rate of spontaneous resolution without treatment (up to 44%).▪The rate to overall progression to LV dysfunction (LV ejection fraction <50%) appears to be low at approximately 4%–5%; and of those patients who exhibit a reduction in LV ejection fraction <50%, most are asymptomatic, without signs or symptoms of clinical heart failure or cardiomyopathy.▪Although success rates are high for catheter ablation and complication rates are low, no treatment approach has zero risk, and any complication in asymptomatic patients, the overwhelming majority (≈95%) of whom will not progress to any clinical cardiomyopathy or will even resolve spontaneously, is tragic.▪A conservative approach with clinical surveillance without offering catheter ablation in asymptomatic patients with PVCs and normal LV size and function should be preferred. Premature ventricular contractions (PVCs) are common. Historically they have been considered benign in the setting of a normal heart, with long-term prognosis in asymptomatic healthy subjects with frequent PVCs showing a similar long-term prognosis to that of a healthy U.S. population, without an increased risk of death.1Kennedy H.L. Whitlock J.A. Sprague M.K. Kennedy L.J. Buckingham T.A. Goldberg R.J. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy.N Engl J Med. 1985; 312: 193-197Crossref PubMed Scopus (438) Google Scholar However, in some patients without structural heart disease PVCs may be a sign of early preclinical cardiomyopathy (arrhythmogenic right ventricular dysplasia, sarcoid), a cause of sudden cardiac death in PVC-induced ventricular fibrillation, or progressive left ventricle (LV) dysfunction with heart failure in the setting of PVC-induced cardiomyopathy.2Haissaguerre M. Shah D.C. Jais P. et al.Role of Purkinje conducting system in triggering of idiopathic ventricular fibrillation.Lancet. 2002; 359: 677-678Abstract Full Text Full Text PDF PubMed Scopus (275) Google Scholar, 3Hoffmayer K.S. Bhave P.D. Marcus G.M. et al.An electrocardiographic scoring system for distinguishing right ventricular outflow tract arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy from idiopathic ventricular tachycardia.Heart Rhythm. 2013; 10: 477-482Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 4Haissaguerre M. Shoda M. Jais P. et al.Mapping and ablation of idiopathic ventricular fibrillation.Circulation. 2002; 106: 962-967Crossref PubMed Scopus (528) Google Scholar, 5Knecht S. Sacher F. Wright M. et al.Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study.J Am Coll Cardiol. 2009; 54: 522-528Crossref PubMed Scopus (191) Google Scholar, 6Marcus G.M. Evaluation and management of premature ventricular complexes.Circulation. 2020; 141: 1404-1418Cr","journal":"Heart Rhythm O2","year":2021,"id":209750,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9577,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":694969,"name":"Kurt S. Hoffmayer","orcid":"0000-0003-0002-2368","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:52:05.171356Z","pmid":"34113924","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}