Focal Pulsed Field Ablation for Premature Ventricular Contractions: A Multicenter Experience.

IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation. Arrhythmia and electrophysiology Pub Date : 2024-09-01 Epub Date: 2024-09-05 DOI:10.1161/CIRCEP.124.012826
Domenico Giovanni Della Rocca, María Cespón-Fernández, Ahmad Keelani, Santi Raffa, Luigi Pannone, Alexandre Almorad, Erwin Ströker, Georgi Borisov, Gezim Bala, Juan Sieira, Giampaolo Vetta, Obaida Alothman, Antonio Sorgente, Charles Audiat, Ingrid Overeinder, Markus Frommhold, Alvise Del Monte, Mark La Meir, Andrea Natale, Gian-Battista Chierchia, J Christoph Geller, Carlo de Asmundis, Andrea Sarkozy
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引用次数: 0

Abstract

Background: Pulsed field ablation (PFA) is a novel technology for catheter-based atrial arrhythmia treatment. Evidence of its application for ventricular arrhythmia ablation is still limited. In this study, we describe the feasibility and efficacy of focal PFA for premature ventricular contraction (PVC) ablation.

Methods: A prospective cohort of 20 patients referred for PVC ablation at 2 centers was enrolled, regardless of the presence of structural heart disease, PVC morphology, or previous ablation attempts. All procedures were performed using the CENTAURI System in combination with contact force sensing catheters and 3-dimensional electroanatomical mapping systems. Energy output and the number of applications were left to the operator's discretion.

Results: Eleven (55%) procedures were conducted under general anesthesia, 6 (30%) under deep sedation, and 3 (15%) under light sedation. Muscular contraction was observed in one case (5%). Median procedural and fluoroscopy times were 95.5 and 6.55 minutes, respectively. The median number of PFA applications was 8 with a median contact force of 10g. A statistically significant (76%) reduction was observed in mean peak-to-peak bipolar electrogram voltage before and after ablation (0.707 versus 0.098 mV; P=0.008). Ventricular irritative firing was observed in 11 (55%) patients after PFA. The median follow-up was 120 days. Acute procedural success was achieved in 17 of 20 (85% [95% CI, 0.70-1]) patients. Two of the patients with procedural failure had late success with >80% clinical PVC burden suppression during follow-up, and 2 of 17 patients with acute success had late PVC recurrence, which accounts for a total of 17 of 20 (85% [95% CI, 0.70-1]) patients with chronic success. Transient ST-segment depression occurred in 1 patient, and the right bundle branch block was induced in 2 others (permanently only in one case).

Conclusions: PVC ablation using a focal PFA is feasible, effective, and safe, with promising acute and long-term results in several ventricular locations. Irritative firing is frequently observed. Coronary evaluation should be considered when targeting the outflow tract.

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局部脉冲场消融治疗室性早搏:多中心经验
背景:脉冲场消融(PFA)是一种基于导管治疗房性心律失常的新型技术。将其应用于室性心律失常消融的证据仍然有限。在本研究中,我们描述了病灶 PFA 用于室性早搏(PVC)消融的可行性和疗效:方法:我们招募了 20 名转诊到 2 个中心接受 PVC 消融术的前瞻性患者,无论他们是否患有结构性心脏病、PVC 形态或之前是否尝试过消融术。所有手术均使用 CENTAURI 系统结合接触力传感导管和三维电解剖图系统进行。能量输出和应用次数由操作者自行决定:11例(55%)手术在全身麻醉下进行,6例(30%)在深度镇静下进行,3例(15%)在轻度镇静下进行。有一例(5%)观察到肌肉收缩。手术和透视时间的中位数分别为 95.5 分钟和 6.55 分钟。PFA应用次数中位数为8次,接触力中位数为10g。消融前后,双极电图平均峰峰值电压明显降低(76%)(0.707 对 0.098 mV;P=0.008)。11 名(55%)患者在 PFA 后观察到心室刺激性发火。中位随访时间为 120 天。20 名患者中有 17 名(85% [95% CI, 0.70-1])获得了急性手术成功。在程序失败的患者中,有两名患者在随访期间获得了晚期成功,临床 PVC 负荷抑制率大于 80%,17 名急性成功患者中有 2 名患者晚期 PVC 复发,因此 20 名慢性成功患者中共有 17 名(85% [95% CI, 0.70-1])获得了晚期成功。1名患者出现短暂的ST段压低,另外2名患者诱发右束支传导阻滞(仅1例为永久性):结论:使用病灶 PFA 进行 PVC 消融是可行、有效和安全的,在多个心室位置都能取得良好的急性和长期效果。经常观察到刺激性点火。以流出道为目标时应考虑冠状动脉评估。
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来源期刊
CiteScore
13.70
自引率
4.80%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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