https://doi.org/10.1007/s00392-025-02625-4
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
Background
Clinical experience applying a novel large footprint focal catheter that can toggle between radiofrequency (RF) and pulsed-field (PF) energy, for ablation in the ventricle is scarce.
Methods
Patients with symptomatic premature ventricular contraction (PVC) or ventricular tachycardia (VT) underwent ventricular mapping and ablation using the lattice-tip catheter (9 mm) applying RF energy (temperature control mode with target temperature of 60° and 40% current limit with 30 s duration) or PF ablation (PFA, 1500 pulses/train, 12 trains/application, 350 ms inter-train delay).
Results
Three patients were included (median age 68 [59; 72] years, 2/3 female, median left ventricular (LV) ejection fraction 40 [30; 42], all patients with implantable cardioverter defibrillator (ICD)). Patient 1 had ischemic cardiomyopathy (CMP), recurrent VTs and received a first procedure of substrate-based RF-ablation basal inferoseptal in the LV. Patient 2 (Figure 1) had non-ischemic CMP after myocarditis, 5 previous VT ablation attempts, recurrent VTs and received RF and PFA at the base of the anterolateral papillary muscle in the LV and RF-ablation at the posterolateral aspect of the right ventricular outflow tract (OT). Patient 3 had non-ischemic CMP, 1 previous VT ablation and frequent symptomatic PVCs and received RF and PFA below the left coronary cusp in the LVOT. At locations with application of both energy forms, RF lesions were set first to estimate clinical effect before subsequent lesion consolidation by PFA. Median number of RF application number was 7 [5; 8] and number of PFA was 6 [4; 8]. Medium ablation time was 200 [195; 250] sec for RF and PF energy. High-density mapping consisted of a median of 2398 [2181; 2740] points. Non-inducibility of VT or PVC elimination of main morphology was achieved in all procedures. Median procedure time was 110 [95; 143] min, median fluoroscopy time 13 [10; 14] min with a median dose area product 456 [324; 561] cGycm2. None of the PFA applications induced VT, ventricular fibrillation or irritative firing >3 s post-ablation, none of the ICDs showed adverse effects during or after the procedure. No major or minor complication occurred.
Conclusion
Large focal-tip catheter-based ablation using RF and PFA energy for VT or PVC showed a high acute success rate and short procedure times without adverse events.