Late left ventricular summit premature ventricular contractions elimination with new TactiFlex irrigation technology
Zefferino Palamà1,2, Giuseppe Tricarico1, Antonio Scarà3
1Department of Cardiology, Casa di Cura Villa Verde, Taranto 74121, Puglia, Italy.
Background:
Premature ventricular contractions (PVCs) originating from the left ventricular summit (LVS) could be challenging to ablate due to anatomical reasons.
Aim:
To study the role of new irrigation technologies, like the TactiFlex catheter, could facilitate deeper radiofrequency (RF) penetration and thus increase success in the ablative treatment of this PVC subset.
Methods:
Three PVCs focus (left bundle branch block morphology, inferior axis on the frontal plane, early R/S transition in V1-V2) were accurately mapped with Ensite X omnipolar technology.
Results:
RF was delivered at mitroaortic continuity by TactiFlex catheter (4-9 lesions, max 35 W, 43 °C, 13 mL/minute, max 60 seconds, mean impedance drop 11.9 ± 1.7 ohms) with acute PVCs suppression but early recurrence in all cases. In one case, an anatomical approach in the posteroseptal right ventricular outflow tract was performed without acute success. After 6-10 hours, no PVCs/ventricular arrhythmias have been detected, and no arrhythmia recurrences in all 3 cases at a 180-day follow-up visit. These data were compared with a cohort of 10 patients with LVS PVCs with immediate disappearance treated with the same technology; the only difference, although not statistically significant, was in the greater drop in impedance (13.5 ± 2.1 ohms).
Conclusion:
Late PVCs elimination could be due to the porous flexible distal tip design of the TactiFlex catheter that allows deeper RF penetration in the myocardium due to a greater adhesion of the saline irrigation system to tissue. It is reasonable to assume that this new technology makes lesions more transmural, determining a delayed lesion maturation, thus not limited to the duration of energy delivery.
