Premature Ventricle Contraction Ablation in Cardiac Sarcoidosis

Background Premature ventricular contractions (PVCs) are common and often benign, but in patients with structural heart disease—including cardiac sarcoidosis (CS)—they may contribute to tachycardia-induced cardiomyopathy, malignant ventricular arrhythmias (VA), and sudden cardiac death. Catheter ablation (CA) is an established therapy for idiopathic PVCs, yet outcomes of PVC ablation in CS remain poorly defined. Methods We retrospectively reviewed consecutive patients with CS undergoing PVC ablation at the Medical University of South Carolina from January 2017 to December 2022. CS was diagnosed per Heart Rhythm Society criteria. Mapping and ablation were performed using CARTO 3 or EnSite NavX electroanatomic systems. Acute success was defined as elimination of clinical PVCs at the end of the procedure. Long-term outcomes included PVC burden reduction (> 80%), symptomatic improvement, ventricular arrhythmia-free survival, and transplant-free survival. Results Eleven patients (55% male, mean age 61 ± 12 years, mean LVEF 46% ± 15) underwent 13 ablation procedures targeting 17 clinically relevant PVCs. Acute elimination of PVCs was achieved in all patients without major procedural complications. During a mean follow-up of 927 ± 618 days, 8 of 11 patients (73%) achieved durable arrhythmia control. Mean PVC burden decreased from 33.5% ± 14 pre-ablation to 1.2% ± 0.4 post-ablation (p < 0.01), with a mean LVEF improvement of 6.8% ± 7.3. Three patients experienced recurrent PVCs, of whom one underwent repeat ablation. One patient developed sustained VT and ultimately required heart transplantation. Overall survival was 100%, and transplant-free survival was 91% at last follow-up. Conclusions PVC ablation in patients with CS is safe and acutely effective, with high rates of long-term arrhythmia suppression, improved ventricular function, and low incidence of subsequent malignant VA. Integration of multidisciplinary sarcoid-directed therapy alongside ablation likely contributes to favorable outcomes. PVC ablation should be strongly considered as part of a comprehensive management strategy in select CS patients.