Background:
Focal pulsed field ablation (PFA) is emerging as a potential alternative to radiofrequency (RF) ablation for premature ventricular complexes (PVCs). Comparative data regarding procedural characteristics, efficacy and safety remain limited.
Methods:
First-do PVC ablation procedures performed with RF or focal PFA using the Centauri system were retrospectively analysed. Procedural characteristics, acute and short-term outcomes, and clinically relevant complications were compared between groups. Short-term success was defined as residual PVC burden ≤5% at follow-up.
Results:
A total of 68 patients were included (age 61.0±15.4 years; 31/67 [46.3%] female), comprising 53 RF and 15 focal PFA first-do PVC ablation procedures. Baseline PVC burden (19.9±8.8% vs 17.6±10.7%; P = .46) was comparable. Procedure duration was 137.2±46.4 vs 120.5±44.4 min (P = .22), and fluoroscopy time was 7.9±4.6 vs 8.4±6.0 min (P = .75). Acute clinical success was achieved in 48/53 RF and 13/15 focal PFA procedures (90.6% vs 86.7%; P = .64). Follow-up data were available in 41 RF and 9 focal PFA patients after a mean follow-up of 3.4±2.2 months. Short-term success after the first procedure was observed in 30/41 RF and 7/9 focal PFA patients (73.2% vs 77.8%; P = 1.00). Major complications occurred in 1/53 RF and 0/15 focal PFA procedures (1.9% vs 0%; P = 1.00), corresponding to one stroke in the RF group. One non-major clinically relevant complication occurred in each group: access-site bleeding after RF and transient coronary spasm after focal PFA, resolving after medical therapy (1.9% vs 6.7%; P = .40).
Conclusion:
In this single-centre analysis, focal PFA for PVC ablation showed acute and short-term efficacy comparable to RF, with a tendency to shorter procedure duration and no increase in major complications. Larger studies are required to confirm these exploratory findings.
