Key result
Very high-power short-duration ablation for PVCs achieved 100% acute elimination, similar to conventional ablation, with significantly shorter median RF delivery time (52 vs 350 seconds; P<0.0001).
Why the study?
Power-controlled radiofrequency ablation is widely used for premature ventricular contractions, but the efficacy, safety, and short-term clinical outcomes of very high-power short-duration ablation for idiopathic outflow tract premature ventricular contractions needed assessment.
Does very high-power short-duration radiofrequency ablation reduce ablation time and maintain safety compared to conventional power-controlled ablation in patients with idiopathic outflow tract PVCs?
Cohort (n=48)
Does very high-power short-duration radiofrequency ablation reduce ablation time and maintain safety compared to conventional power-controlled ablation in patients with idiopathic outflow tract PVCs?
Absolute Event Rate: 100% vs 100%
Very high-power short-duration ablation for outflow tract PVCs significantly reduces radiofrequency delivery time without compromising safety or efficacy compared to conventional ablation.
May support vHP-SD ablation for OT PVCs; leaves open randomized confirmation of efficacy and durability.
Objectives: We sought to assess the efficacy, safety and short-term clinical outcome of very high-power short-duration (vHP-SD) radiofrequency (RF) catheter ablation for the treatment of idiopathic PVCs originating from the cardiac outflow tract (OT). Background: Power-controlled RF ablation is a widely used technique for the treatment of premature ventricular contractions (PVCs). A novel ablation catheter offers three microelectrodes and six thermocouples at its tip and provides temperature-controlled vHP-SD (90 Watts/4 s,) with the opportunity to switch to moderate-power mode. Methods: In this pilot study, twenty-four consecutive, prospectively enrolled patients underwent PVC ablation utilizing the vHP-SD ablation (study group) and were compared with 24 consecutive patients previously treated with power-controlled ablation (control group). Each group included 12 patients with PVCs originating from the right ventricular OT (RVOT) and 12 patients with PVCs originating from the left ventricular OT (LVOT). The acute endpoint was PVC elimination and was achieved in all patients. Results: In 16/24 (67%) patients (study group) it was achieved by using vHP-SD only. The median RF delivery time was 52 (interquartile range [IQR] 16, 156) seconds (study group) and 350 (IQR 240, 442) seconds (control group, p < 0.0001). No difference was observed regarding procedure duration (p = 0.489) as well as 6-months follow-up (p = 0.712). One (4%, study group) and 2 (8%, control group) severe adverse events occured (p = 0.551). Conclusion: vHP-SD PVC ablation was similarly effective and safe as compared to conventional power-controlled ablation. The RF time was significantly shorter.
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Heeger et al. (2022) conducted a cohort in idiopathic premature ventricular contractions originating from the cardiac outflow tract (n=48). very high-power short-duration (vHP-SD) radiofrequency (RF) catheter ablation vs. conventional power-controlled ablation was evaluated on acute PVC elimination. Very high-power short-duration ablation for PVCs achieved 100% acute elimination, similar to conventional ablation, with significantly shorter median RF delivery time (52 vs 350 seconds; P<0.0001).
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