Feasibility and midterm effectiveness of focal pulsed field ablation for ventricular arrhythmias

Abstract

Background: Pulsed field ablation (PFA) is a promising novel method of atrial ablation, with preclinical data suggesting it to be a viable option for ventricular arrhythmias.

Objective: The objective was to report the feasibility, safety, and clinical efficacy of PFA for ventricular arrhythmias.

Methods: All patients (N = 35) scheduled for ablation of premature ventricular complexes (PVCs; n = 24) or ventricular tachycardia (VT; n = 11) underwent focal PFA by use of a pulsed field generator and irrigated ablation catheters. Procedural and clinical outcomes were evaluated by 3-month Holter monitoring, implantable cardioverter-defibrillator home monitoring, and chart review.

Results: A total of 11 (31%) patients had experienced previously failed radiofrequency ablation. Most PVCs (58%) originated from the outflow tracts, and most VTs were caused by ischemic cardiomyopathy (55%). Average procedure time was 187 ± 59 minutes. Acute procedural success was achieved in 91% of the patients. PFA was delivered combined endocardially and through the cardiac venous system in 25% of the PVC patients. During a mean follow-up of 288 ± 149 days, the success was 75% for PVCs and 45% for VTs. A total of 5 patients were reablated during follow-up (4 VT, 1 PVC). We observed 7 (20%) minor and 2 (6%) major complications including 2 transient conduction system blocks related to pulsed field delivery and 1 stroke and 1 minor stroke.

Conclusion: Focal PFA exhibited satisfactory acute effectiveness for PVC and VT, but favorable clinical effectiveness was retained only in PVC patients. More data are needed to establish lesion durability, safety, and limitations of PFA in ventricular tissue.

Keywords: Effectiveness; Electrophysiology; Feasibility; Focal; Premature ventricular complex; Pulsed field ablation; Safety; Ventricular arrhythmias; Ventricular tachycardia.