Early Elimination of Premature Ventricular Contractions in Heart Failure

A common way to get rid of PVCs is an ablation procedure during which a small area of heart
muscle that creates the PVCs is cauterized, so that it can no longer cause PVCs. This has
been performed for many years and is an overall safe and effective procedure to eliminate
PVCs. In the ablation, a catheter with an electrode at its tip is guided with moving X-rays
(fluoroscopy) displayed on a video screen to the exact site inside the heart where cells
give off the electrical signals that stimulate the abnormal heart rhythm. Radiofrequency
energy (similar to microwave heat) is transmitted from the catheter tip to the area. This
destroys carefully selected heart muscle cells in a very small area (about 1/5 of an inch)
and can stop the area from creating the extra impulses that cause the extra heartbeats.
Additionally, some medications have the ability to suppress PVCs (antiarrhythmic
medications). PVC ablation and antiarrhythmic medications have both been used to treat
patients with PVC's and a reduced heart function. The heart function is referred to as
ejection fraction (measured by cardiac ultrasound (echocardiogram). In this study it will be
required the ejection fraction will be less than less than or equal to 45% (with 55% or more
being normal).

If enrolled in the study there is a 50/50 chance (like a coin toss and referred to as
randomization) that the patient will either continue on the best currently available medical
treatment for a weak heart muscle (as determined by the doctor) or will undergo a PVC
catheter ablation (with a possible second ablation or antiarrhythmic medication, if the
first ablation was not a success).

All patients in the study will continue to take the best possible medications for the heart
muscle weakness. If the patient is randomized to not undergo the ablation they will be
monitored and at the end of 6 months of participation may choose to have the PVC ablation.
If a deterioration may occur patients in the control group can have an ablation earlier.

Inclusion Criteria:

- Patients with reduced ejection fraction (EF ≤45%) demonstrated by transthoracic
echocardiogram and deemed to be non-ischemic by nuclear stress test or cardiac
catheterization.

- Patients with >20% PVCs on 24 hour holter-recording

- Patient is 18 years of age or older

- Optimized medical therapy on stable therapy for minimum 3 months with no changes in
beta-blocker, ACE-I/ARB, digoxin doses (varying diuretic doses permitted).

Exclusion Criteria:

- Patients who are under the age of 18 years of age

- Patients with >2 dominant PVC morphologies

- Patients with cardiac surgery in previous 3 months or scheduled for following 6
months

- Patients who were implanted with a biventricular device during the last three months
or single/dual chamber device (with ventricular pacing >10%) during the last three
months

- Significant symptoms associated with PVCs that would make favor immediate ablation

- Intracardiac mural thrombus or myxoma

- Pregnancy