TY - JOUR
T1 - Focal Pulsed Field Ablation for Premature Ventricular Contractions
T2 - A Multicenter Experience
AU - HRMC Investigators
AU - Della Rocca, Domenico Giovanni
AU - Cespón-Fernández, María
AU - Keelani, Ahmad
AU - Raffa, Santi
AU - Pannone, Luigi
AU - Almorad, Alexandre
AU - Ströker, Erwin
AU - Borisov, Georgi
AU - Bala, Gezim
AU - Sieira, Juan
AU - Vetta, Giampaolo
AU - Alothman, Obaida
AU - Sorgente, Antonio
AU - Audiat, Charles
AU - Overeinder, Ingrid
AU - Frommhold, Markus
AU - Del Monte, Alvise
AU - La Meir, Mark
AU - Natale, Andrea
AU - Chierchia, Gian-Battista
AU - Geller, J Christoph
AU - de Asmundis, Carlo
AU - Sarkozy, Andrea
N1 - Publisher Copyright:
© 2024 American Heart Association, Inc.
PY - 2024/9
Y1 - 2024/9
N2 - BACKGROUND: Pulsed field ablation (PFA) is a novel technology for catheter-based atrial arrhythmia treatment. Evidence of its application for ventricular arrhythmia ablation is still limited. In this study, we describe the feasibility and efficacy of focal PFA for premature ventricular contraction (PVC) ablation.METHODS: A prospective cohort of 20 patients referred for PVC ablation at 2 centers was enrolled, regardless of the presence of structural heart disease, PVC morphology, or previous ablation attempts. All procedures were performed using the CENTAURI System in combination with contact force sensing catheters and 3-dimensional electroanatomical mapping systems. Energy output and the number of applications were left to the operator's discretion.RESULTS: Eleven (55%) procedures were conducted under general anesthesia, 6 (30%) under deep sedation, and 3 (15%) under light sedation. Muscular contraction was observed in one case (5%). Median procedural and fluoroscopy times were 95.5 and 6.55 minutes, respectively. The median number of PFA applications was 8 with a median contact force of 10g. A statistically significant (76%) reduction was observed in mean peak-to-peak bipolar electrogram voltage before and after ablation (0.707 versus 0.098 mV; P=0.008). Ventricular irritative firing was observed in 11 (55%) patients after PFA. The median follow-up was 120 days. Acute procedural success was achieved in 17 of 20 (85% [95% CI, 0.70-1]) patients. Two of the patients with procedural failure had late success with >80% clinical PVC burden suppression during follow-up, and 2 of 17 patients with acute success had late PVC recurrence, which accounts for a total of 17 of 20 (85% [95% CI, 0.70-1]) patients with chronic success. Transient ST-segment depression occurred in 1 patient, and the right bundle branch block was induced in 2 others (permanently only in one case).CONCLUSIONS: PVC ablation using a focal PFA is feasible, effective, and safe, with promising acute and long-term results in several ventricular locations. Irritative firing is frequently observed. Coronary evaluation should be considered when targeting the outflow tract.
AB - BACKGROUND: Pulsed field ablation (PFA) is a novel technology for catheter-based atrial arrhythmia treatment. Evidence of its application for ventricular arrhythmia ablation is still limited. In this study, we describe the feasibility and efficacy of focal PFA for premature ventricular contraction (PVC) ablation.METHODS: A prospective cohort of 20 patients referred for PVC ablation at 2 centers was enrolled, regardless of the presence of structural heart disease, PVC morphology, or previous ablation attempts. All procedures were performed using the CENTAURI System in combination with contact force sensing catheters and 3-dimensional electroanatomical mapping systems. Energy output and the number of applications were left to the operator's discretion.RESULTS: Eleven (55%) procedures were conducted under general anesthesia, 6 (30%) under deep sedation, and 3 (15%) under light sedation. Muscular contraction was observed in one case (5%). Median procedural and fluoroscopy times were 95.5 and 6.55 minutes, respectively. The median number of PFA applications was 8 with a median contact force of 10g. A statistically significant (76%) reduction was observed in mean peak-to-peak bipolar electrogram voltage before and after ablation (0.707 versus 0.098 mV; P=0.008). Ventricular irritative firing was observed in 11 (55%) patients after PFA. The median follow-up was 120 days. Acute procedural success was achieved in 17 of 20 (85% [95% CI, 0.70-1]) patients. Two of the patients with procedural failure had late success with >80% clinical PVC burden suppression during follow-up, and 2 of 17 patients with acute success had late PVC recurrence, which accounts for a total of 17 of 20 (85% [95% CI, 0.70-1]) patients with chronic success. Transient ST-segment depression occurred in 1 patient, and the right bundle branch block was induced in 2 others (permanently only in one case).CONCLUSIONS: PVC ablation using a focal PFA is feasible, effective, and safe, with promising acute and long-term results in several ventricular locations. Irritative firing is frequently observed. Coronary evaluation should be considered when targeting the outflow tract.
KW - Humans
KW - Ventricular Premature Complexes/physiopathology
KW - Male
KW - Female
KW - Middle Aged
KW - Prospective Studies
KW - Treatment Outcome
KW - Catheter Ablation/methods
KW - Feasibility Studies
KW - Aged
KW - Electrophysiologic Techniques, Cardiac
KW - Time Factors
KW - Adult
KW - Action Potentials
KW - Heart Rate
UR - http://www.scopus.com/inward/record.url?scp=85203345524&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.124.012826
DO - 10.1161/CIRCEP.124.012826
M3 - Article
C2 - 39234745
VL - 17
SP - 581
EP - 592
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
SN - 1941-3149
IS - 9
M1 - e012826
ER -