Arrhythmias & electrophysiology
Safety and Midterm Outcome of Focal Pulsed Field Ablation for Outflow Tract Premature Ventricular Contractions: A Prospective Multicenter Study
Authors' conclusion
Focal PFA provides high acute success and acceptable mid-term efficacy for OT PVCs, with outcomes comparable to contemporary RFA for RVOT and endocardial LVOT sites. Efficacy was lower for left ventricular summit and intramural substrates. Repeat procedures after failed RFA showed particularly favorable results. Coronary vasospasm occurred when PFA was delivered within the great cardiac vein/anterior interventricular vein, suggesting that venous PFA should be considered only after endocardial and alternative mapping/ablation strategies have been exhausted.
Study context
- Population
- Patients with symptomatic outflow tract premature ventricular contractions (PVCs) undergoing focal monopolar pulsed field ablation (PFA) using the CENTAURI generator
- Participants
- 80 patients
Methodological details4 European centers
- 4 European centers
Main finding
As reported in the abstract
- Acute procedural success was achieved in all
Observational data: associations, not effects.
Further findings
Clinical success (>80% reduction in daily PVC burden off antiarrhythmic drugs) · median follow-up of 8 months
- Clinical success
- 88%
PVC burden · median follow-up of 8 months
- Before the procedure
- 21.4% (Q1-Q3: 11.9%-30.0%)
- At follow-up
- 0.0% (Q1-Q3: 0.0%-2%)
- Reduction
- P < 0.001
PVC origin
- Right ventricular OT (RVOT)
- 61%
Success rates by ablation site
- RVOT
- 94%
- Endocardial left ventricular OT (LVOT)
- 89%
- Left ventricular summit
- 72%
No recurrence among patients with prior failed radiofrequency ablation (RFA)
- Of patients with prior failed RFA, no recurrence
- 14 (93%) of 15
Nitroglycerin use
- Procedures with nitroglycerin
- 68 (85%) of 80
Safety
Complications
- Major (ischemic stroke)
- One major (ischemic stroke; 1%)
- Minor
- 7 minor (9%)
Coronary vasospasm during ablation in the great cardiac vein/anterior interventricular vein
- Of patients ablated in the great cardiac vein/anterior interventricular vein
- 2 (17%) of 12
- Resolved with additional nitroglycerin administration
Right bundle branch block during RVOT ablation
- Patients
- 2 patients (1 transient, 1 permanent)
Original publication
Summarised from the published abstract; every number is checked against it