Focal monopolar pulsed field ablation from within the great cardiac vein for idiopathic premature ventricular contractions after failed radiofrequency ablation.
Heart Rhythm
; 21(10): 1877-1887, 2024 Oct.
Article
em En
| MEDLINE
| ID: mdl-38971417
ABSTRACT
BACKGROUND:
Idiopathic epicardial premature ventricular contractions (PVCs) originating from the left ventricular summit are difficult to eliminate.OBJECTIVE:
The purpose of this study was to describe the feasibility and procedural safety of monopolar biphasic focal pulsed field ablation (F-PFA) from within the great cardiac vein (GCV) for treatment of idiopathic epicardial PVCs.METHODS:
In 4 pigs, F-PFA (Centauri, CardioFocus) was applied from within the GCV followed by macroscopic gross analysis. In 4 patients with previously failed radiofrequency ablation, electroanatomic mapping was used to guide F-PFA from within the GCV and the ventricular outflow tracts. Coronary angiography and optical coherence tomography (OCT) were performed in 2 patients.RESULTS:
In pigs, F-PFA from within the GCV (5 mm away from the coronary arteries) resulted in myocardial lesions with a maximal depth of 4 mm, which was associated with nonobstructive transient coronary spasms. In patients, sequential delivery of F-PFA in the ventricular outflow tracts and from within the GCV eliminated the PVCs. During F-PFA delivery from within the GCV with prophylactic nitroglycerin application, coronary angiography showed no coronary spasm when F-PFA was delivered >5 mm away from the coronary artery and a transient coronary spasm without changes in a subsequent OCT, when F-PFA was delivered directly on the coronary artery. Intracardiac echocardiography and computed tomography integration was used to monitor F-PFA delivery from within the GCV. There were no immediate or short-term complications.CONCLUSION:
Sequential mapping-guided F-PFA from endocardial ventricular outflow tracts and from within the GCV is feasible with a favorable procedural safety profile for treatment of epicardial PVCs.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Angiografia Coronária
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Ablação por Cateter
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Complexos Ventriculares Prematuros
Limite:
Animals
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Heart Rhythm
Ano de publicação:
2024
Tipo de documento:
Article