PFA ablation safe, effective for treating premature ventricular contractions
![Focal pulsed field ablation (PFA) is a safe, effective treatment option for premature ventricular contractions (PVC), according to new data published in Circulation: Arrhythmia and Electrophysiology.[1]](/sites/default/files/styles/top_stories/public/2024-09/screenshot_2024-09-25_at_1.12.29_pm.png.webp?itok=tcrlATun)
Focal pulsed field ablation (PFA) is a safe, effective treatment option for premature ventricular contractions (PVC), according to new data published in Circulation: Arrhythmia and Electrophysiology.[1]
“Limited evidence on PFA-based ventricular arrhythmia treatment has been reported to date, only including individual case reports or short case series,” wrote first author Domenico Giovanni Della Rocca, MD, PhD, a researcher with Heart Rhythm Management Center in Belgium and Texas Cardiac Arrhythmia Institute in Austin, Texas, and colleagues.
The group performed a small study focused on 20 patients referred for PVC ablation at one of two facilities. All patients were treated with the CardioFocus Centauri PFA system, which has gained CE mark approval, but is not yet approved by the U.S. Food and Drug Administration for commercial use in the United States. PFA energy selection was left up to each operator.
The median patient age was 59 years old, and 65% were women. Four patients had already had at least one failed ablation attempt using radiofrequency energy. While two patients had a left ventricular systolic dysfunction with an ejection fraction less than 40%, the other 18 presented with idiopathic PVC.
Fifty-five percent of procedures were performed under general anesthesia, 30% were performed under deep sedation and 15% were performed under light sedation. This was left up to the preferences of both the operator and the patient. When general anesthesia was used, the patient’s neuromuscular block was monitored during treatment using a thumb sensor.
The median number of PFA applications was eight and median contact force was 10 grams. The median procedure and fluoroscopy times were 95.5 and 6.55 minutes, respectively.
A “remarkable” reduction was seen in mean peak-to-peak bipolar electrogram voltage before and after ablation, and acute success was seen in 85% of patients. One procedure was aborted due to “difficulties related to vessel tortuosity and significant cardiac remodeling secondary to severe pulmonary hypertension.”
Two patients experienced a periprocedural complication. One patient showed signs of transient ST-segment depression, and another patient developed a femoral artery pseudoaneurysm following treatment.
After a median follow-up period of 120 days, the long-term success rate was 85%. Complete PVC elimination was seen in 60%, and “a significant reduction in PVC burden” was seen in another 25%.
“PVC ablation using a focal PFA delivery system is feasible, effective, and safe, with promising acute and long-term results especially in the outflow tract and possibly in a variety of other anatomic locations,” the authors concluded. “Light sedation appears feasible and might be critical to prevent the impact of general anesthesia on PVC burden.”
Click here to read the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.