Focal monopolar pulsed field ablation from within the great cardiac vein for idiopathic premature ventricular contractions after failed radiofrequency ablation

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY

ACS Applied Materials & Interfaces Pub Date : 2024-10-01 DOI:10.1016/j.hrthm.2024.07.002

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Abstract

Background

Idiopathic epicardial premature ventricular contractions (PVCs) originating from the left ventricular summit are difficult to eliminate.

Objective

The purpose of this study was to describe the feasibility and procedural safety of monopolar biphasic focal pulsed field ablation (F-PFA) from within the great cardiac vein (GCV) for treatment of idiopathic epicardial PVCs.

Methods

In 4 pigs, F-PFA (Centauri, CardioFocus) was applied from within the GCV followed by macroscopic gross analysis. In 4 patients with previously failed radiofrequency ablation, electroanatomic mapping was used to guide F-PFA from within the GCV and the ventricular outflow tracts. Coronary angiography and optical coherence tomography (OCT) were performed in 2 patients.

Results

In pigs, F-PFA from within the GCV (5 mm away from the coronary arteries) resulted in myocardial lesions with a maximal depth of 4 mm, which was associated with nonobstructive transient coronary spasms. In patients, sequential delivery of F-PFA in the ventricular outflow tracts and from within the GCV eliminated the PVCs. During F-PFA delivery from within the GCV with prophylactic nitroglycerin application, coronary angiography showed no coronary spasm when F-PFA was delivered >5 mm away from the coronary artery and a transient coronary spasm without changes in a subsequent OCT, when F-PFA was delivered directly on the coronary artery. Intracardiac echocardiography and computed tomography integration was used to monitor F-PFA delivery from within the GCV. There were no immediate or short-term complications.

Conclusion

Sequential mapping-guided F-PFA from endocardial ventricular outflow tracts and from within the GCV is feasible with a favorable procedural safety profile for treatment of epicardial PVCs.

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从心脏大静脉内进行局部单极脉冲场消融，治疗射频消融失败后的特发性室性早搏。

背景：特发性心外膜室性早搏（PVC）起源于左心室顶部，很难消除：描述从心脏大静脉（GCV）内进行病灶单极双相脉冲场消融（F-PFA）治疗特发性心外膜早搏的可行性和手术安全性：方法：在 4 头猪的心脏大静脉内应用 F-PFA（CENTAURI，Cardiofocus），然后进行宏观大体分析。在 4 例射频消融失败的患者中，使用电解剖图引导从 GCV 和心室流出道内进行 F-PFA。对2名患者进行了冠状动脉造影和光学相干断层扫描（OCT）：结果：在猪身上，从 GCV 内（距冠状动脉 5 毫米处）进行 F-PFA 会导致最大深度为 4 毫米的心肌病变，这与非阻塞性一过性冠状动脉痉挛有关。在患者中，在心室流出道和 GCV 内连续输送 F-PFA 可消除 PVC。在从 GCV 内输送 F-PFA 并预防性应用硝酸甘油期间，冠状动脉造影显示，当 F-PFA 输送到距离冠状动脉大于 5 毫米处时，冠状动脉无痉挛；而当 F-PFA 直接输送到冠状动脉上时，则会出现短暂的冠状动脉痉挛，但在随后的 OCT 中无变化。心内回声和计算机断层扫描集成用于监测从 GCV 内输送 F-PFA。没有出现直接或短期并发症：结论：在心内膜心室流出道和 GCV 内进行顺序映射引导的 F-PFA 是可行的，而且治疗心外膜 PVC 的程序安全性良好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.