Dual-modality focal catheter ablation using pulsed field and/or radiofrequency energy achieved acute and durable suppression of refractory left ventricular summit PVCs in all 6 treated patients.
Observational (n=6)
Does dual-modality focal ablation (pulsed field and radiofrequency) reduce PVC burden and symptoms in patients with refractory left ventricular summit PVCs?
In a first-in-human experience, dual-modality focal ablation effectively suppressed refractory left ventricular summit PVCs, though transient coronary vasospasm was observed.
Background: Radiofrequency (RF) ablation of premature ventricular complexes (PVCs) originating from the left ventricular summit (LVS) may be unsuccessful, highlighting the need for alternative approaches. We aimed to assess the efficacy and safety of a novel dual-modality focal catheter in treating LVS PVCs in patients who failed previous RF ablation. Methods: Patients were prospectively enrolled and underwent a redo-ablation procedure using an irrigated, contact-force sensing, dual-modality focal catheter (TactiFlex™ Duo, Abbott) under compassionate use indication. The ablation strategy, including the choice of energy modality (monopolar pulsed field PF, RF or both), was left to the operator's discretion. Safety assessments included serial biomarkers, renal function, and cardiac MRI within 36 hours. Efficacy was defined as ≥80% reduction in PVC burden with symptom resolution at 3-month follow-up. Results: Six consecutive patients (4 male, mean age 53.8±15 years) with symptomatic LVS PVCs and a prior failed RF ablation (range 1-2) were prospectively enrolled. All PVCs had an inferior axis, with a left bundle V1 morphology observed in 4 out of 6 cases (mean burden: 30.1±5.3%). Acute suppression of PVCs was achieved in all cases. Acute suppression with a single PF application in the GCV-AIV occurred in 2 patients, while 3 patients required additional RF, PF, or combined RF+PF applications at adjacent sites. One patient with an inaccessible GCV-AIV was successfully treated in the LVOT with RF+PF application. Transient, reversible LAD vasospasm was observed during PF delivery in 2 of 5 cases who underwent PF application adjacent to a coronary artery, despite pre-treatment with intracoronary (IC) nitroglycerin without ECG or hemodynamic sequalae. All patients had durable suppression of PVCs at follow-up. Conclusions: In its first human application, dual-modality ablation was feasible and effective for refractory LV summit PVCs. Transient coronary vasospasm occurred, though it was reversible and without acute clinical consequence.
Patil et al. (Fri,) conducted a observational in Treatment Refractory Left Ventricular Summit PVCs (n=6). Dual-modality focal catheter ablation (pulsed field and/or radiofrequency) was evaluated on ≥80% reduction in PVC burden with symptom resolution at 3-month follow-up. Dual-modality focal catheter ablation using pulsed field and/or radiofrequency energy achieved acute and durable suppression of refractory left ventricular summit PVCs in all 6 treated patients.