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Very High-Power Short-Duration Ablation for Premature Ventricular Complexes From Sites With Suboptimal Catheter

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Very high-power short-duration (vHPSD) ablation effectively treated premature ventricular complexes (PVCs) originating from papillary muscles. This study shows vHPSD ablation is a safe and durable option for challenging PVC cases.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Very high-power short-duration (vHPSD) ablation is established for atrial fibrillation but its use for premature ventricular complexes (PVCs) is not well-defined.
  • Targeting PVCs in challenging locations like papillary muscles requires precise ablation techniques.

Purpose of the Study:

  • To evaluate the safety and efficacy of vHPSD ablation for PVCs originating from intracavitary structures, specifically papillary muscles.
  • To assess vHPSD ablation in cases with suboptimal catheter contact during PVC ablation.

Main Methods:

  • Retrospective analysis of 8 patients undergoing vHPSD ablation for PVCs.
  • Utilized a temperature-controlled ablation catheter (QDOT-MICRO) delivering lesions at 90W for 4 seconds in QMODE+ mode.
  • Focused on PVCs originating from left ventricular (LV) and right ventricular (RV) papillary muscles.

Main Results:

  • Successful elimination of PVCs in all 8 patients, with PVC burden decreasing from a mean of 23.3% to <1%.
  • PVCs originated from LV papillary muscles (n=7) and RV papillary muscle (n=1).
  • No procedural complications were observed, and durable PVC suppression was confirmed post-ablation.

Conclusions:

  • vHPSD ablation using a temperature-controlled RF catheter is safe and effective for PVC ablation.
  • This technique is particularly useful in challenging anatomical regions with poor catheter stability, such as RV and LV papillary muscles.