Ablation outcomes in PVC-induced cardiomyopathy: A systematic review and meta-analysis stratified by site of origin

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.