Non-endocardial radiofrequency ablation of premature ventricular
complexes (NERA-PVC): safety, efficacy and outcome.
Abstract
Background: Radiofrequency(RF) ablation of premature ventricular
complexes(PVCs) is a well-established treatment for patients high PVCs
burden, even when arising from epicardial/intramural localization.
Consistent data about safety of using high power RF is lacking in
literature in these regions. Aim: The aim of this study is to
investigate safety of different RF power settings, efficacy and outcome
of non-endocardial PVCs ablation. Methods: Consecutive patients who
underwent PVC ablation were included (2017-2023). We defined
“Non-Endocardial Radiofrequency Ablation”(NERA) a procedure in which
at least one ablation site has been identified into the cardiac venous
system, aortic cusps, inter-leaflet region or pulmonary cusps.
Results: Total number of NERA sites was 64 in 53 procedures. In 63%
of the procedures, high power (≥40W) and in 60% long duration (≥60
seconds) RF was delivered in at least one site (mean power:37±9W(15-50),
mean duration of single RF 88±65 seconds (30-304)). In 21% of the
procedures, a combination of both high power and long duration RF
applications was performed. Procedural success was achieved in 47
procedures(84%). Only one severe complication (pericardial bleeding)
was observed. In 22(39%) procedures, multisite ablation was performed
which was associated with procedural failure (OR 7,47;p=0,01). During
follow-up, mean and median PVC burden reduction were 69±41% and 96%
respectively. Multisite ablation and coronary venous system RF were
predictors of recurrence (HR 3.6;p=0.026 and HR 3.85;p=0.014).
Conclusion: Ablation from non-endocardial sites is a safe and
effective procedure, even using high power and/or long duration RF with
clear benefit in terms of PVC burden reduction.