Pulsed field ablation as a feasible option for the treatment of epicardial left ventricular summit premature complex foci near the coronary arteries: a case report.

Background: Radiofrequency catheter ablation in the left ventricular summit region is a challenging procedure due to proximity to the coronary arteries. Pulsed field ablation, a novel non-thermal ablation modality, does not cause damage to coronary arteries and may be used in the left ventricular summit region.

Case summary: We describe a 45-year-old symptomatic patient with epicardial left ventricular summit premature ventricular complexes. Successful ablation of the focus was achieved by pulsed field ablation via a subxiphoid epicardial approach. Radiofrequency ablation would most likely have been ineffective due to the epicardial fat layer and potentially unsafe due to the proximity to the coronary arteries. Six months after ablation, the patient was asymptomatic and without ventricular ectopy.

Discussion: For the first time, epicardial pulsed field ablation was successfully used for ablation of left ventricular summit extrasystole, where radiofrequency ablation could not be used because of the proximity of the coronary arteries. We conclude that pulsed field ablation might be a feasible option for this indication.