Efficacy and safety of focal pulsed-field ablation for ventricular arrhythmias: two-centre experience
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.
EP Europace, Volume 26, Issue 7, July 2024, euae192, https://doi.org/10.1093/europace/euae192
Published: 11 July 2024
Mapping and ablation of ventricular tachycardia using dual-energy lattice-tip focal catheter: early feasibility and safety study
Background
Catheter ablation is an effective treatment method for recurrent ventricular tachycardias (VT). However, at least in part, procedural and clinical outcomes are limited by challenges in generating an adequate lesion size in the ventricular myocardium.
Objective
We investigated procedural and clinical outcomes of VT ablation using a novel “large-footprint” catheter that allows the creation of larger lesions either by radiofrequency (RF) or by pulsed field (PF) energy.
Results
The study population consisted of 18 patients (aged 55±15 years, 1 woman, structural heart disease: 94%, ischemic heart disease: 56%, left ventricular ejection fraction: 34±10%, electrical storm: 22%) with recurrent sustained VTs and ≥1 previously failed endocardial RF ablation with conventional irrigated-tip catheter in 66% of patients. On average, 12±7 RF and 8±9 PF applications were delivered per patient. In 3/4 of patients undergoing percutaneous epicardial ablation, spasms in coronary angiography were observed after PF applications. All resolved after intracoronary administration of nitrates. No acute phrenic nerve palsy was noted. One patient suffered from a stroke that resolved without sequelae. Post-ablation non-inducibility of VT was achieved in 89% of patients. Ventricular-arrhythmia-free survival at three months was 78%.
Conclusion
VT ablation using a dual-energy lattice-tip catheter and a novel electroanatomical mapping system is feasible. It allows rapid mapping and effective substrate modification with good outcomes during short-term follow-up.
EP Europace, euae275, https://doi.org/10.1093/europace/euae275
Published: 31 October 2024
