Comparative efficacy of pharmacological and non-pharmacological management of monomorphic right ventricular premature contractions in patients without structural heart disease

Olesin A.I., Konstantinova I.V., Tyuteleva N.N., Zueva I.S.

To date, antiarrhythmic medication and radiofrequency ablation (RFA) are the primary methods of right ventricular premature contractions (PVCs) management in patients without structural heart disease (SHD). Aim of the study. The aim of the study was to evaluate the efficacy of pharmacological and non-pharmacological (RFA) strategies of monomorphic right ventricular PVCs management, depending on the identification of arrhythmogenic cardiomyopathy (ACM) predictors in patients without SHD.

Methods. In this study, 452 patients with high frequency of PVCs (mean 23529±561 PVCs per day) and without SHD aged 16-39 were observed. In addition to the basic parameters, such ACM predictors as the QRS complex maximum intrinsicoid deflection index, QRS complex duration, etc. were electrocardiographically assessed. The observation period was 5 years.

Results. In 95.13% of patients the early monotopic right ventricular PVCs without ACM predictors were diagnosed. No cardiovascular diseases developed in these patients, and Class I antiarrhythmic drugs were the most effective at suppressing ventricular ectopy. In this group, 15.71% of the patients declined the longterm antiarrhythmic therapy or RFA. The rest of the group continued pharmacologic therapy. In 95.28% of patients with the early monotopic right ventricular PVC without registered ACM predictors, the duration of antiarrhythmic therapy, according to the “therapeutic sufficiency” principle, was 11.1 ± 0.3 months from the beginning of the period of observation. This duration highly correlated (r = 0.89) with the observation period of patients receiving cardioprotective therapy. In 4.87% of patients with registered right ventricular PVC with ACM predictors, no effect of antiarrhythmic therapy was observed and/or clinically significant heart failure developed. These patients underwent RFA for ventricular ectopy management. In all patients of this subgroup RFA induced remission and in 85.71% of them remained free of PVC recurrence throughout the entire follow-up period.

Conclusion. Patients with the early monotopic right ventricular PVCs, without SHD and any ACM predictors treatment with Class I antiarrhythmics was the most effective, while in patients with monomorphic right ventricular PVCs and ACM predictors, RFA was the effective therapeutic option.

Keywords: Premature ventricular contractions, antiarrhythmic therapy personalization, pharmacologic treatment, radiofrequency ablation.

For citation: Olesin A.I., Konstantinova I.V., Tyuteleva N.N., Zueva I.S. Comparative efficacy of pharmacological and non-pharmacological management of monomorphic right ventricular premature contractions in patients without structural heart disease. 2025. 13(47):4-10. DOI 10.24412/2311-1623-2025-47-5-12