Pulsed field ablation with a pentaspline catheter for ventricular arrhythmias: First US series

Abstract

Background: Pulsed field ablation (PFA) with a pentaspline catheter has recently been approved by the US Food and Drug Administration for catheter ablation of atrial fibrillation. Evidence of its application for ablation of ventricular arrhythmias remains limited.

Objective: The purpose of this study was to evaluate the safety and efficacy of pentaspline PFA for ventricular arrhythmias.

Methods: We included consecutive patients undergoing PFA with a pentaspline catheter for ventricular tachycardia (VT) or premature ventricular contractions (PVCs) between May and October 2024. PFA was used for large-footprint VT substrate ablation in patients with large scars or as a bailout approach after acute radiofrequency failure.

Results: A total of 11 patients (mean age, 70 ± 7 years; left ventricular ejection fraction, 35% ± 12%) were included. In 9 patients, PFA was used for VT (7 with ischemic cardiomyopathy and 2 with nonischemic cardiomyopathy), and in 2 patients for papillary muscle PVCs (1 who underwent concomitant atrial fibrillation ablation). In 4 patients, PFA was performed after acute radiofrequency ablation (RFA) failure and was successful in suppressing the targeted VT/PVC in all cases. In 7 patients, PFA was performed for large VT substrate modification or PVC: in 2 patients, only PFA was used, whereas in the remaining 5 patients, touch-up RFA was used to complete substrate modification. Noninducibility of VT/PVC was achieved in all cases. During a mean follow-up of 6 months, VT recurred in 2 patients and PVC in 1. No procedural-related complications occurred.

Conclusion: In this first US series, VT/PVC ablation using a pentaspline PFA catheter for large VT substrate modification or after acute RFA failure appeared effective and safe, with promising acute and mid-term follow-up results.

Keywords: Arrhythmogenic right ventricular cardiomyopathy; Electroanatomic map; Pentaspline catheter; Premature ventricular contractions; Pulsed field ablation; Substrate modification; Ventricular arrhythmia; Ventricular tachycardia.