Acute and one year outcome of premature ventricular contraction ablation guided by contact force and automated pacemapping software

Abstract

Background Radiofrequency (RF) ablation is a well‐established approach to treat premature ventricular contractions (PVC) and is associated with good outcomes. Aim The present study sought to analyze the acute efficacy and 1‐year outcomes of PVC ablation using RF technology with an approach based on automated pace‐mapping and contact force (CF) information. Methods Sixty‐one consecutive patients (52.4% males, age 45.9 ± 12.5) underwent catheter ablation for symptomatic monomorphic PVC. All procedures were guided by a 3‐dimensional mapping system; site of ablation was selected based on PASO ™ aided pace‐mapping; RF was started on the selected location when stable catheter position with >10 g of CF were obtained. The procedure was defined as acutely effective if the PVC was eliminated and it did not recur during within 30 minutes. Long‐term efficacy was defined as a decrease by more than 95% at 1 year of the initial PVC burden at ECG Holter monitoring. Results The PVC ablation was performed in the right ventricular outflow tract in 37 patients (60.7%), left ventricle in 15 patients (24.6%), coronary cusps in 6 patients (9.8%), right ventricle in 3 patients (4.9%); PVC ablation was acutely successful in 59 of patients (96.7%). At 1‐year efficacy was obtained in 57 patients (93.4%). No major complications occurred. Mean procedural and fluoroscopy time were 94.5 ± 20.9 and 4.3 ± 2.5 minutes respectively. Conclusion Premature ventricular contraction RF ablation mainly guided by PASO ™ and CF showed high success rate in both acute and 1‐year follow‐up (96.7% and 93.4% respectively). The best efficacy cut‐off for RF ablation of PVCs has been identified in presence of both PASO ™ ≥95% and CF >10 g.

Pre‐procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes

“…Idiopathic PVC ablation was successful in 72% of our patients, which is well within the range of previously reported outcomes 4,12 . The observed complication rate of 3% is in line with published reports, 4,13 indicating high procedural safety.…”

Similar outcomes with manual contact force ablation catheters and traditional catheters in the treatment of outflow tract premature ventricular complexes

“…Capulzini et al . 17 report that the mean force value reached in their 61 patients ablated for PVCs was 18.3 ± 6.4 g. Their impressively high acute success rate of 96.7% and 1-year recurrence-free rate of 93.4% suggest that besides their accurate mapping strategy, these force values should be enough to create durable lesions. Of note, their study had no comparator arm; all cases were ablated with CFS catheters.…”

Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

“…Additionally, in the TOCCATA study, cardiac perforation was linked to excessive CF based on blinded CFS measurements [19]. On the contrary, in previously published data and our study results, there is no evidence of the significant implication of the CFS catheter on safety during ventricular RFCA, independent of the presence of structural heart disease, arrhythmia localization, or fluoroscopy use [14,15,18,[24][25][26]. Novel techniques are introduced in cardiac electrophysiology [27].…”