Non-Endocardial Radiofrequency Ablation of Premature Ventricular Complexes (NERA-PVC): Safety, Efficacy and Outcome.

Background: Radiofrequency (RF) ablation of premature ventricular complexes (PVCs) is a well-established treatment for patients high PVCs burden, even when arising from epicardial/intramural localization. Consistent data about safety of using high power RF is lacking in the literature in these regions.

Aim: The aim of this study is to investigate the safety of different RF power settings, efficacy and outcome of non-endocardial PVCs ablation.

Methods: Consecutive patients who underwent PVC ablation were included (2017-2023). We defined "Non-Endocardial Radiofrequency Ablation"(NERA) a procedure in which at least one ablation site has been identified into the CVS, aortic cusps, inter-leaflet region or pulmonary cusps.

Results: Total number of NERA sites was 64 in 56 procedures. In 63% of the procedures, high power (≥ 40 W) and in 60% long duration (≥ 60 s) RF was delivered in at least one site (median power: 40 W(30-40), median duration of single RF 54 s(45-91). In 21% of the procedures, a combination of both high power and long duration RF applications was performed. Overall procedural success was achieved in 46 procedures 82%), complete in 39 (70%), partial in 7 (12%). Only one severe complication (pericardial bleeding) was observed. Multisite ablation was associated with procedural failure. During follow-up, median PVC burden was 0.5%(0.5-9.5), with a median reduction of 97%. Multisite ablation and coronary venous system RF were predictors of recurrence (HR 3.6; p = 0.03) and HR 3.85; p = 0.02).

Conclusion: Ablation from non-endocardial sites is a safe and effective procedure, even using high power and/or long duration RF with clear benefit in terms of PVC burden reduction.