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

While very high-power short-duration (vHPSD) ablation has been shown to be safe and effective for ablation of atrial fibrillation, the utility of vHPSD ablation for targeting premature ventricular complexes (PVCs) remains unclear. We aimed to describe our experience of PVC ablation using vHPSD ablation targeting areas with suboptimal catheter contact.

We included 8 patients (mean age 66.5 ± 11.3 years, 77% female gender, mean LV ejection fraction 52.8 ± 8.2%, baseline PVC burden 23.3 ± 10.1% [range 9-41%]) with PVCs originating from intracavitary structures [LV papillary muscle(s) (n = 7), RV papillary muscle (n = 1)] which were successfully eliminated with vHPSD ablation using a temperature-controlled ablation catheter (QDOT-MICRO; Biosense Webster, Irvine, California, USA) with lesions delivered at 90 W for 4 seconds using QMODE+ mode. Mean QMODE+ lesions delivered in each patient was 28 ± 15.1 with a mean total QMODE+ RF time of 112 ± 60.4 seconds. There were no procedural complications. Durable PVC suppression was confirmed on post-ablation monitoring in all patients (mean post-ablation PVC burden < 1% [range 0-2.3%]).

Ablation with vHPSD using a temperature-controlled radiofrequency ablation catheter can be safe and effective for PVC ablation in regions with poor catheter stability such as RV and LV papillary muscles.