Distal-to-proximal delay for ablation of premature ventricular contractions.

INTRODUCTION: Ablation of premature ventricular contractions has emerged as a safe and effective treatment in patients experiencing a high premature ventricular contractions burden. Mapping of premature ventricular contractions origin may sometimes be challenging. We sought to evaluate the accuracy of a new electrophysiological criterion, the Distal-to-Proximal Delay, at localizing the optimal site for ablation of ventricular ectopic foci.

METHODS AND RESULTS: Consecutive patients with ablation attempts of symptomatic premature ventricular contractions were included. Prematurity and Distal-to-Proximal Delay - i.e., time duration between the onset of ablation catheter distal bipolar electrogram and the onset of proximal bipolar electrogram - were measured at successful and unsuccessful ablation sites by 3 blinded experienced electrophysiologists. Mean Distal-to-Proximal Delay at effective ablation sites (N=30) was significantly higher than at ineffective sites (N=55) (23±9 vs 11±8 ms, p<0.0001). Distal-to-Proximal Delay had good to excellent interrater reliability. A Distal-to-Proximal Delay ≥15 ms had the highest accuracy at predicting a successful ablation site (sensitivity 0.97, area under ROC curve 0.87, p<0.0001).

CONCLUSION: Distal-to-Proximal Delay is an additional, simple and effective electrophysiological parameter to accurately localize premature ventricular contractions foci. This article is protected by copyright. All rights reserved.