Catheter Ablation -> Ventricular Arrhythmias -> Ablation Techniques D-PO05 - Poster Session V (ID 39) Poster

D-PO05-191 - Intramural Needle Ablation For Refractory Premature Ventricular Contractions (ID 587)


Background: Conventional RFA is often successful in eliminating PVCs. However, an intramural focus is a common cause for failed ablation due to the inability of standard ablation techniques to access certain deep myocardial foci.
Objective: We assessed the efficacy and safety of irrigated needle ablation (INA) in patients with refractory PVCs using a novel ablation catheter equipped with an extendable/retractable needle designed to target intramural substrate.
Methods: Under FDA approved, non-randomized, prospective, investigator-initiated protocols, INA (Biosense Webster Inc) was evaluated in patients with frequent PVCs refractory to conventional ablation. Initial targets were selected by endocardial/epicardial mapping and the 27-g needle was extended up to 10 mm into the myocardium for recording and pacing. After contrast injection for location assessment, radiofrequency energy was applied with saline irrigation from the needle (max temp 60oC)
Results: At 4 centers, 33 pts (age 56.0 ± 16.7 yrs, 72.7% male) underwent INA. The PVC burden was 26.7 ± 10.8%, LVEF was 37.8 ± 12.6%, and number of prior ablations was 1.9 ± 0.8. Delivering 10.5 ± 8.2 lesions/pt, INA resulted in acute PVC elimination in 24 pts (72.7%), decreased PVC burden in 3 (9.1%), and failure in 6 (18.2%). Complications occurred in 5 pts: 2 pericardial effusions (1 requiring drainage), 1 intermittent AV block, 1 pericarditis, 1 femoral artery dissection. In the 24 pts completing monitoring, the mean PVC burden decreased from 26.3 ± 11.3% to 6.8 ± 11.0% at 119 ± 87 days follow up (Figure).
Conclusion: Irrigated needle ablation is a promising therapy for the treatment of patients with otherwise refractory intramural PVCs.