Non-Endocardial Radiofrequency Ablation of Premature Ventricular Complexes (NERA-PVC): Safety, Efficacy and Outcome

Radiofrequency (RF) ablation of premature ventricular complexes (PVCs) is a well-established treatment for patients high PVCs burden, even when arising from epicardial/intramural localization. Consistent data about safety of using high power RF is lacking in the literature in these regions.

The aim of this study is to investigate the safety of different RF power settings, efficacy and outcome of non-endocardial PVCs ablation.

Consecutive patients who underwent PVC ablation were included (2017-2023). We defined "Non-Endocardial Radiofrequency Ablation"(NERA) a procedure in which at least one ablation site has been identified into the CVS, aortic cusps, inter-leaflet region or pulmonary cusps.

Total number of NERA sites was 64 in 56 procedures. In 63% of the procedures, high power (≥ 40 W) and in 60% long duration (≥ 60 s) RF was delivered in at least one site (median power: 40 W(30-40), median duration of single RF 54 s(45-91). In 21% of the procedures, a combination of both high power and long duration RF applications was performed. Overall procedural success was achieved in 46 procedures 82%), complete in 39 (70%), partial in 7 (12%). Only one severe complication (pericardial bleeding) was observed. Multisite ablation was associated with procedural failure. During follow-up, median PVC burden was 0.5%(0.5-9.5), with a median reduction of 97%. Multisite ablation and coronary venous system RF were predictors of recurrence (HR 3.6; p = 0.03) and HR 3.85; p = 0.02).

Ablation from non-endocardial sites is a safe and effective procedure, even using high power and/or long duration RF with clear benefit in terms of PVC burden reduction.