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Observational Study
. 2024 Jul 2;26(7):euae192.
doi: 10.1093/europace/euae192.

Efficacy and safety of focal pulsed-field ablation for ventricular arrhythmias: two-centre experience

Petr Peichl  1 , Alan Bulava  2 , Dan Wichterle  1 , Filip Schlosser  1 , Predrag Stojadinović  1 , Eva Borišincová  1 , Peter Štiavnický  1 , Jana Hašková  1 , Josef Kautzner  1
Affiliations
Observational Study

Efficacy and safety of focal pulsed-field ablation for ventricular arrhythmias: two-centre experience

Petr Peichl et al. Europace. .

Abstract

Aims: A pulsed electric field (PF) energy source is a novel potential option for catheter ablation of ventricular arrhythmias (VAs) as it can create deeper lesions, particularly in scarred tissue. However, very limited data exist on its efficacy and safety. This prospective observational study reports the initial experience with VA ablation using focal PF.

Methods and results: The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA.

Conclusion: Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.

Keywords: Catheter ablation; Pulsed-field energy; Ventricular premature complexes; Ventricular tachycardia.

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Conflict of interest statement

Conflict of interest: P.P. reports personal fees from Biotronik, Biosense Webster, Boston Scientific, Medtronic, and St. Jude Medical (Abbott). A.B. reports personal fees from Biotronik for participation in the scientific advisory board and has received speaker honoraria from Biotronik, Boston Scientific, and St. Jude Medical (Abbott). J.K. reports personal fees from Biosense Webster, Boston Scientific, GE Healthcare, Medtronic, and St. Jude Medical (Abbott) for participation in scientific advisory boards and has received speaker honoraria from Biosense Webster, Biotronik, Boston Scientific, Medtronic, and St. Jude Medical (Abbott). The remaining authors have no disclosures.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
An illustrative case of ablation in the great cardiac vein in a patient with non-ischaemic cardiomyopathy and scar-related VT from the LV summit. (A) shows prematurity (−40 ms) and fragmentation during the VPC in the decapolar catheter positioned close to the substrate in the great cardiac vein (CS 3.4). Note relatively late activation in the ablation catheter positioned on the endocardium of the LV outflow tract. (B) shows the corresponding pace map with a long stimulus-to-QRS delay. (C) depicts angiography of the left coronary artery position prior to ablation. No spasm (D) was noted after four PF applications in the great cardiac vein. (E and F) display electroanatomical maps in anteroposterior (E) and modified cranial view (F). Ao, aorta; ABL, electrograms from ablation catheter; CS, coronary sinus; GCS, great cardiac vein; LV, left ventricular; PF, pulsed field; RV, right ventricle; VPC, ventricular premature complex.
Figure 2
Figure 2
(A) shows the occurrence of complete AV block after PF ablation in a patient with non-ischaemic cardiomyopathy. (B) depicts an electroanatomical voltage map. The distance between the site of the application leading to the AV block and the location of His bundle recordings was 4 cm. (C) displays the fluoroscopic position of the ablation catheter. Note that the location of the proximal ring electrode on the catheter shaft is at the His bundle area (see text for further explanation). A, amper; AVB, AV block; His, his bundle recording site; LAO, left anterior oblique view; PF, pulsed field.
Figure 3
Figure 3
Kaplan–Meier curve of sustained VT-free survival after PF ablation. PF, pulsed field; VT, ventricular tachycardia.
See this image and copyright information in PMC

References

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