Feasibility and long-term effectiveness of focal pulsed field ablation for ventricular arrhythmias

Abstract Background Pulsed field ablation (PFA) is a novel method of cardiac ablation showing promising results in atrial tissue with preclinical data suggesting it to be a viable option for ventricular arrhythmias. The aim of this study was to report the feasibility, safety, and clinical efficacy of PFA for ventricular arrhythmias. Methods All-comer patients scheduled for ablation of premature ventricular complexes (PVC) or ventricular tachycardia (VT) (n=35, 24 PVC, 11 VT) were prospectively included and underwent focal PFA using a PF generator and irrigated ablation catheters. Procedural and clinical outcomes were evaluated with 3-months Holter monitoring and implantable cardioverter defibrillator home monitoring, read-outs and chart review. Results A total of 11 (31%) of the patients had experienced previously failed radiofrequency ablation. Most PVC (58%) originated from the outflow tracts and most VTs were caused by ischemic cardiomyopathy (55%). Average procedure time was 187 ± 59 minutes. An acute procedural success was achieved in 91% of the patients. PFA was delivered combined endocardially and through the cardiac venous system in 25% of the PVC patients. During a mean follow-up of 288 ± 149 days the long-term success was 75% for PVCs and 45% for VTs. A total of 5 patients were re-ablated during follow-up (4 VT, 1 PVC). We observed 7 (20%) complications including two transient conduction system blocks related to PF delivery and one stroke and one minor stroke. Conclusion Focal PFA was a highly efficient method to achieve procedural success for both PVC and VT procedures with favourable long-term outcome seen for PVC ablation only. More data is needed to establish lesion depth, durability, safety, and limitations of PFA in ventricular tissue.