Catheter Ablation Versus Anti-arrhythmic Drugs for Premature Ventricular Complexes

Inclusion Criteria

1. PVC burden of ≥10% as determined by ≥24-hour heart rhythm monitoring.
2. Normal left ventricular ejection fraction, defined as ejection fraction ≥50%.
3. Aged ≥18 years.
4. Symptoms due to PVCs according to the judgement of the treating physician.

Exclusion Criteria

1. Unable or unwilling to provide informed consent or comply with study requirements including study investigations, follow-up, medical adherence and completion of the assigned intervention.
2. Women who are pregnant or breastfeeding.
3. Life expectancy ≤12 months.
4. Ventricular tachycardia (VT), defined as spontaneous VT lasting ≥30 seconds, haemodynamically unstable VT of any duration, inducible sustained VT during any electrophysiology study, or ≥10 episodes of non-sustained VT (\>5 consecutive beats lasting ≤30 seconds) within 24 hours on heart rhythm monitoring.
5. Previous catheter ablation for ventricular arrhythmia.
6. Clinically significant coronary artery disease, defined as a history of myocardial infarction, prior coronary revascularisation, inducible ischaemia on functional testing or obstructive coronary artery disease on coronary imaging. Any type of coronary assessment is permitted, although computed tomography coronary angiography is encouraged.
7. Moderate or greater valvular heart disease.
8. Known non-ischaemic or ischaemic cardiomyopathy or evidence of myocardial scar on cardiac magnetic resonance imaging suggestive of structural heart disease.
9. Known cardiac channelopathies including catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome and long- or short-QT syndrome.
10. In the opinion of the investigator or responsible physician, participation would not be in the patient's best interest or the patient would be unable to complete study procedures because of concomitant illness, physical impairment or mental condition.