Focal monopolar pulsed field ablation from within the great cardiac vein for idiopathic premature ventricular contractions after failed radiofrequency ablation.

Autor:	Chaldoupi SM; Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Nissen SD; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Vriesendorp PA; Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Farnir FIP; Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Jerltorp K; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Linz B; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Johannessen A; Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark., Haugdal MA; Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark., Luermans JGLM; Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Saljic A; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Jespersen T; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Hansen J; Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark., Linz D; Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: dominik.linz@mumc.nl.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Oct; Vol. 21 (10), pp. 1877-1887. Date of Electronic Publication: 2024 Jul 04.
DOI:	10.1016/j.hrthm.2024.07.002
Abstrakt:	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. Competing Interests: Disclosures The authors have no conflicts to disclose. (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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