# The utility of 24-h electrocardiogram recordings for the prediction of a sufficient number of premature ventricular complexes and mapping strategy during catheter ablation

## TL;DR

This study examines how 24-hour ECG recordings can predict whether enough heart rhythm irregularities will occur during ablation procedures to allow accurate mapping.

## Contribution

The study identifies a threshold of PVCs in 24-h ECGs that can predict sufficient PVCs for mapping during ablation.

## Key findings

- A threshold of >10,000 PVCs per 24-h ECG predicts a sufficient number of PVCs with 67% positive predictive value.
- Patients using activation mapping had more PVCs in 24-h ECGs compared to those using pace mapping.
- The number of PVCs in 24-h ECGs was moderately associated with successful electroanatomical mapping.

## Abstract

An insufficient number of premature ventricular complexes (PVCs) during catheter ablation (CA) may prohibit adequate mapping of the site of origin. Parameters to predict this situation have not been established. Our objective was to quantify the association between preprocedural information and the probability of a sufficient number of PVCs for adequate mapping and successful CA.

Clinical characteristics and results from examinations and procedural data were collected retrospectively from health journals for patients admitted for CA of PVCs from 2011 to 2020.

In total, 46 of 332 patients (14%) had an insufficient number of PVCs to enable adequate electroanatomical mapping. Patients with a sufficient number of PVCs had nominally more PVCs in the 24-h electrocardiogram (ECG), with a strong statistical trend [16,007 (6,509–26,205) vs. 8,332 (3,066–20,974), p = 0.055]. The receiver operator curve for a sufficient number of PVCs in 24-h ECGs had an area under the curve of 0.610 (95% CI 0.498–0.722, p = 0.055). The best predictive values were found at >10,000 PVCs per 24-h, with a positive predictive value of 67% and a negative predictive value of 57%. Patients for whom activation mapping was used as the sole mapping method had more PVCs in the 24-h ECG than did patients for whom pace mapping was added or used as an alternative [19,769 (10,564–30,526) vs. 15,237 (6,000–25,033), p = 0.022]. Neither acute outcome nor procedure time depended on the mapping strategy.

The number of PVCs in a 24-h ECG was moderately associated with the presence of a sufficient number of PVCs to perform electroanatomical mapping during CA. The presence of more PVCs in the preprocedural 24-h ECG was associated with the use of activation mapping as the sole mapping strategy.