Single shot electroporation of premature ventricular contractions from the right ventricular outflow tract
Boris Schmidt, Shaojie Chen, Shota Tohoku, Stefano Bordignon, Fabrizio Bologna, K. R. Julian Chun
Abstract
The first approved ablation device for pulsed field ablation (PFA, FARAWAVE) consists of a 12-Fr catheter with five splines carrying four electrodes each that is navigated over-the-wire via a steerable sheath. Its shape can be changed from a basket-like pose to a flower-like pose depending on the underlying anatomy. In this case, a 48-year-old female with symptomatic premature ventricular contractions (PVCs) was referred for ablation. PVC morphology was compatible with an origin in the right ventricular outflow tract (RVOT). Conventional mapping with a diagnostic catheter confirmed RVOT site of origin. A steerable sheath (FARADRIVE) was advanced to the right atrium. Using a 6F pigtail catheter a guidewire was deployed in the left pulmonary artery. The 31-mm FARAWAVE ablation catheter was deployed in the RVOT in a basket like pose. Pulsed field ablation was carried out using pulses of 2.5 s duration with a voltage of 1.8 kV. After the first energy application PVCs were completely abolished. No complications were observed. Before discharge 48-h Holter monitoring showed complete abolition of PVCs. To the best of our knowledge, this is the first description of PFA for the clinical treatment of ventricular arrhythmias in humans. The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.