Pulsed field ablation for idiopathic premature ventricular complexes: evaluation of acute and chronic lesion characteristics with cardiac magnetic resonance imaging.

Background: To date, data about pulsed field ablation (PFA) for ventricular arrhythmias are limited, and cardiac magnetic resonance (CMR) characteristics of acute and chronic PFA lesions in the ventricles have not been described. This study sought to examine feasibility and efficacy of premature ventricular complex (PVC) ablation using focal PFA, as well as assess acute and chronic lesion characteristics using CMR.

Methods: This was a prospective, single-arm study performed at two centers in China. Consecutive patients with frequent, symptomatic PVCs were consented and recruited. All procedures were performed using a comprehensive cardiac PFA system. PVC burden evaluation and CMR were performed before the procedure, within 3 days, and at approximately 6 months post-procedure.

Results: Twelve patients (mean age 54 ± 14 years, 41.7% female) were included and underwent ablation. The PVCs originated in the right ventricular outflow tract in seven (58.3%) patients, the left ventricular outflow tract in three (25%) patients, the left anterior papillary muscle in one (8.3%) patient and para-Hisian septum in one (8.3%) patient, respectively. Nine (75%) patients had complete elimination of PVCs after PFA. The PFA lesions were visualized and quantified by CMR in 6 out of 12 patients. The median volume evaluated by acute late gadolinium enhancement was 726 (430, 1544) mm³ and significantly decreased to 445 (288, 715) mm³ in the chronic stage (P = 0.031).

Conclusion: PFA showed favorable efficacy and safety in patients with frequent PVCs. CMR imaging allows clear visualization and quantitative analysis of PFA lesions, which showed a significant size regression from acute to chronic period.