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Non-endocardial radiofrequency ablation of premature ventricular complexes (NERA-PVC): safety, efficacy and outcome.
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  • Pasquale Valerio Falzone,
  • Sara Vazquez-Calvo,
  • Jean Baptiste Guichard,
  • Till Althoff,
  • Paz Garre,
  • Jose Maria Tolosana,
  • Eduard Guasch,
  • Roger Borras,
  • Luis Mont Girbau,
  • Andreu Porta-Sanchez,
  • Ivo Roca-Luque
Pasquale Valerio Falzone
Hospital Clinic de Barcelona
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Sara Vazquez-Calvo
Hospital Clinic de Barcelona
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Jean Baptiste Guichard
Hospital Clinic de Barcelona
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Till Althoff
Hospital Clinic de Barcelona
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Paz Garre
Hospital Clinic de Barcelona
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Jose Maria Tolosana
Hospital Clinic de Barcelona
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Eduard Guasch
Hospital Clinic de Barcelona
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Roger Borras
Hospital Clinic de Barcelona
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Luis Mont Girbau
Hospital Clinic de Barcelona
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Andreu Porta-Sanchez
Hospital Clinic de Barcelona
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Ivo Roca-Luque
Hospital Clinic de Barcelona

Corresponding Author:[email protected]

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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.
Submitted to Journal of Cardiovascular Electrophysiology
27 May 2024Reviewer(s) Assigned
18 Jun 2024Review(s) Completed, Editorial Evaluation Pending
24 Jun 2024Editorial Decision: Revise Minor