Pulsed field ablation of ventricular arrhythmias arising from intracavitary structures: insights from a clinical case series.

Introduction: Premature ventricular complexes (PVCs) from intracavitary structures, such as papillary muscles and the moderator band, can be challenging to treat. Pulsed field ablation (PFA) offers a novel strategy for treating these arrhythmias.

Methods: Between 2023 and 2024, three patients with intracavitary PVCs (two with PVC-mediated ventricular fibrillation) underwent PFA at a tertiary referral centre. Electroanatomic mapping was performed and, with intracardiac echocardiography (ICE) guidance, PFA was delivered using a pentaspline Farapulse catheter, with adjuvant radiofrequency (RF) ablation as needed.

Results: All patients had successful abolition of PVCs. PFA delivery was feasible and safe, with excellent success despite prior RF ablation failures though one patient required adjuvant RF ablation. The only complication was a persistent right bundle branch block (RBBB) after PFA delivery to the moderator band. Follow-up showed significant reductions in PVC burden and no further ventricular fibrillation (VF) episodes. The mean procedural duration was 153.67 ± 31.71 min, and the mean fluoroscopy time was 14.38 ± 6.74 min.

Conclusion: This is a preliminary proof of concept report for ablation of PVCs from intracavitary structures, warranting further validation studies.