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Safety and Efficacy of Catheter Ablation of Premature Ventricular Contractions Arising from the Coronary Cusp

https://doi.org/10.1007/s00392-025-02737-x

Philipp Lucas (Bad Oeynhausen)1, M. Didenko (Bad Oeynhausen)1, N. Trajkovska (Bad Oeynhausen)1, D. Guckel (Bad Oeynhausen)2, M. El Hamriti (Wetzikon)3, T. Fink (Bad Oeynhausen)1, V. Sciacca (Bad Oeynhausen)1, M. Braun (Bad Oeynhausen)1, S. Waezsada (Bad Oeynhausen)4, G. Imnadze (Bad Oeynhausen)1, S. Beyer (Bad Oeynhausen)1, C. Sohns (Bad Oeynhausen)1, P. Sommer (Bad Oeynhausen)1, M. Khalaph (Bad Oeynhausen)1

1Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/ Rhythmologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/Rhythmologie Bad Oeynhausen, Deutschland; 3GZO Spital Wetzikon Klinik für Kardiologie und Angiologie Wetzikon, Schweiz; 4Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland

 

Background:

Frequent premature ventricular contractions (PVCs) can lead to symptoms and cardiomyopathy. Those arising from the coronary cusps pose unique challenges due to their proximity to critical structures. Limited data exist on the safety and efficacy of ablation in this region.

 

Objective:

The study aimed to evaluate the safety, procedural success and anatomical feasibility of catheter ablation of PVCs originating from the left coronary cusp (LCC), right coronary cusp (RCC), and the RCC/LCC-commissure.

 

Methods:

A total of 114 patients were included in this retrospective, monocentre study between 2019 and 2024. All patients suffered from PVCs originating from the RCC (50.0%, n = 57), LCC (33.3%, n = 38) or the RCC/LCC commissure (16.7%, n = 19) (Figures 1 and 2) and underwent catheter ablation. Procedural success, complications, and short-term outcomes were assessed.

To further investigate these results, anatomical feasibility was assessed using a separate cardiac computed tomography (cCT) database of 6,555 patients who underwent TAVI screening at our institution between 2009 and 2024. This imaging analysis focused on measuring the distance from the aortic annulus to the coronary ostia, providing anatomical evidence for the safety and feasibility of ablation in the coronary valve area.

 

Results:

Catheter ablation was successfully performed in all 114 patients (Age 58±13 years, 61% male). No major or minor complications were observed. Transthoracic echocardiography showed no structural or functional damage to the aortic valve or other cardiac structures. 

No pericardial effusion or electrocardiographic abnormalities were detected. A 24-hour Holter ECG performed one day post-ablation confirmed a 0% burden of clinical PVCs in all cases. Analysis of the cCT database showed an anatomically adequate distance from the aortic annulus to the coronary ostia, supporting the safety of ablation in the coronary cusps, with averages of 17 ± 4 mm for the right and 14 ± 3 mm for the left coronary artery.

 

Conclusion:

Ablation of PVCs from the coronary cusps is safe and highly effective, with no complications and complete arrhythmia suppression. Anatomical data support the feasibility of this approach in appropriately selected patients.

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