Use of a Focal Pulsed Field Ablation Catheter to Target Premature Ventricular Contractions From the Papillary Muscle

Figures

• 

  Figure 1. Premature Ventricular Contraction Localization and Ablation in Patient 1 (A) In patient 1, right anterior oblique and inferior views of electroanatomic activation maps of the left ventricle and anterolateral papillary muscle are shown, along with shadows of the ablation catheter. The site of early activation (red area) is shown. (B) The earliest electrogram (yellow arrow) identified on the grid mapping catheter demonstrated a local activation −35 milliseconds earlier than the surface QRS. (C) The earliest electrogram identified by the focal pulsed field ablation (PFA) ablation catheter had a local activation −41 milliseconds presurface QRS. PFA lesions were delivered to this location.

• 

  Figure 2. Premature Ventricular Contraction Localization and Ablation in Patient 2 (A) The focal pulsed field ablation catheter was positioned along the site of earliest activation using intracardiac ultrasound and electroanatomic mapping guidance. (B) The premature ventricular contraction morphology and electrograms recorded from the ablation catheter are shown at the site of earliest activation −34 milliseconds pre-QRS.

• 

  Figure 3. Benefits of PFA in the Ablation of Papillary Muscle PVCs The challenges of ablating papillary muscle PVCs using conventional thermal energy and the benefits offered using PFA are shown. PFA = pulsed field ablation; PVC = premature ventricular contraction.