Use of a Focal Pulsed Field Ablation Catheter to Target Premature Ventricular Contractions From the Papillary Muscle

The papillary muscles are a common site of origin for premature ventricular contractions (PVCs). Radiofrequency ablation of these PVCs is often challenging due to catheter instability and the inability to penetrate fibrotic tissue, leading to limited clinical success in PVC suppression. In this report, we describe the use of pulsed field ablation (PFA), delivered via a novel focal ablation catheter, to successfully treat papillary muscle PVCs in 2 symptomatic, treatment-refractory patients. Both patients had previously undergone at least 1 failed ablation attempt using conventional radiofrequency catheters but achieved durable suppression or reduction in PVC burden after a limited number of PFA applications. Neither patient experienced complications related to the delivery of PFA energy. Although the safety and efficacy of PFA within the ventricle are still being explored, its rapid energy delivery and ability to penetrate fibrotic tissue may make it uniquely suited for ablation of PVCs originating from papillary muscles.