Clinical Characteristics and Determinants of Ventricular Arrhythmias After Self‐Expandable Pulsta Valve Implantation in the Native Right Ventricular Outflow Tract

BACKGROUND: Ventricular arrhythmias (VA) after percutaneous pulmonary valve implantation (PPVI) have been mainly reported with balloon-expandable valves. Data on VA following self-expandable valves, particularly the Pulsta valve, remain limited. AIMS: To evaluate the incidence, clinical characteristics, and predictors of clinically significant VA after Pulsta valve implantation in patients with native right ventricular outflow tract (RVOT) disease. METHODS: We retrospectively reviewed 129 consecutive patients who underwent PPVI with the Pulsta valve. All patients received continuous telemetry monitoring until discharge. Clinically significant VA was defined as VA requiring antiarrhythmic therapy. Clinical, electrocardiographic, RVOT morphological, and valve-related variables were analyzed using univariable logistic regression. RESULTS: The median age at PPVI was 27 years (interquartile range, 22.0-36.0). Over a median follow-up of 3.3 years, any VA occurred in 42 patients (32.6%), predominantly transient premature ventricular complexes (PVCs; 16.3%) or non-sustained ventricular tachycardia (VT; 16.3%). Among patients with non-sustained VT, antiarrhythmic therapy was required in 5 patients (3.9%), with only 2 patients (1.6%) remaining on medication at discharge. No sustained VT, hemodynamic instability, or persistent arrhythmia requiring long-term therapy was observed. Proximal RVOT implantation was the strongest predictor of VA (odds ratio 5.74, 95% confidence interval 1.08-30.57 vs. mid/distal RVOT, p = 0.039). Other clinical, electrocardiographic, anatomical, and valve-related factors were not associated with VA. CONCLUSIONS: In patients with native RVOT disease treated with self-expandable Pulsta valve, clinically significant VA was rare, and most VAs were benign and self-limited. Pulsta valve implantation at proximal RVOT was the key determinant of VA risk.