PVC Termination Time: A Novel Real-Time Predictor of Ablation Success

Abstract Background: During PVC ablation, operators need real-time feedback to optimize outcomes. We hypothesized that PVC Termination Time (PTT)—the interval from radiofrequency onset to PVC disappearance—would outperform local activation time (LAT) in predicting acute success. Objectives: To evaluate the predictive value of PTT compared with LAT in PVC ablation. Methods: We analyzed 310 applications in 54 patients undergoing PVC ablation. PTT and LAT were measured for each application. Acute success was defined as elimination of PVCs without recurrence within 30 minutes. ROC and logistic regression analyses were performed, with location-specific analyses and long-term follow-up. Results: Acute success was achieved in 50/54 patients (92.6%). PTT was significantly shorter in successful versus failed applications (median 12s [IQR 8–18] vs 62s [IQR 45–75], p<0.0001). LAT was earlier in successful applications (–36 ms vs –26.5 ms, p<0.01). PTT showed superior predictive accuracy (AUC=0.93) versus LAT (AUC=0.72). A PTT cutoff of 25s yielded 88% sensitivity and 83% specificity. Location-specific analysis showed variability, especially in LV summit cases. In multivariable analysis, both shorter PTT (p<0.001) and earlier LAT (p=0.005) predicted success. Long-term follow-up (18±6 months, n=48) demonstrated 85.4% freedom from recurrence; recurrent cases had longer PTT during index ablation (28.5s vs 11.5s, p=0.008). Conclusions: PTT is a practical, real-time predictor of acute PVC ablation success, outperforming LAT. A 25-second cutoff provides objective procedural guidance, though anatomical variations should be considered. CONDENSED ABSTRACT We evaluated PVC Termination Time (PTT)—the interval from radiofrequency onset to PVC disappearance—as a predictor of ablation success in 54 patients (310 applications). PTT was significantly shorter in successful versus failed applications (median 12s vs 62s, p<0.0001) and demonstrated superior predictive accuracy (AUC=0.93) compared to local activation time (AUC=0.72). A 25-second PTT cutoff provided 88% sensitivity and 83% specificity. Location-specific PTT showed variations, with LV summit demonstrating wider variability (IQR 5-38s). PTT offers a practical, real-time metric for guiding PVC ablation procedures, potentially improving efficiency and outcomes.