Low Power Long Duration Ablation for High Impedance Left Ventricular Summit PVCs

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• High-impedance targets in the left ventricular summit pose challenges for standard ablation techniques.
• Coronary venous access is an alternative route for epicardial ablation, but requires careful power titration.

Purpose of the Study:

• To evaluate the safety and efficacy of low-power, long-duration (LPLD) ablation for challenging high-impedance left ventricular summit premature ventricular contraction (PVC) sites accessed via the anterior interventricular vein.

Main Methods:

• LPLD ablation (≤ 25 W for ≥ 60 s with 30 mL/min irrigation) was applied to high-impedance (≥ 150 Ω) PVC sites.
• Power was escalated stepwise (10 W → 12 W → 15 W → 18 W) under strict safety monitoring.
• Computer simulations predicted safe lesion formation at 20 W, while 30 W risked steam-pop events.

Main Results:

• The LPLD ablation approach achieved 66.7% acute success in eliminating target PVCs.
• No complications were reported during the procedure.
• Simulations indicated a safe therapeutic window for lesion creation, avoiding excessive temperatures.

Conclusions:

• LPLD ablation is a safe and effective strategy for treating high-impedance PVCs in the left ventricular summit via the coronary veins.
• This technique offers a promising alternative for complex ablation cases that are difficult to treat with conventional methods.