Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
J Cardiovasc Electrophysiol. 2024 Nov;35(11):2230-2236. doi: 10.1111/jce.16418. Epub 2024 Aug 26.
Due to its unique features, pulsed field ablation (PFA) could potentially overcome some limitations of current radiofrequency (RF) ventricular tachycardia (VT) ablation. However, data on the use of PFA in this setting are currently scarce.
Two patients with ischemic cardiomyopathy and previously failed RF VT ablations were treated with PFA.
A total of 18 bipolar applications (case1) and seven bipolar applications (case2) were delivered to the infero-lateral and infero-septal areas (case1) and to the apical lateral left ventricular (LV) wall (case2), placing the catheter adjacent to the LV wall in the flower configuration. A rapid cessation of VT and restoration of sinus rhythm were observed during PFA delivery in both cases. Further applications were delivered to achieve complete elimination of late potentials. In case 1, during the in-hospital stay, ECG monitoring did not show VT recurrences. Six-month follow-up was uneventful, with no VT recurrences at ICD interrogation. In case 2, due to postdischarge VT recurrences, a second RF procedure was scheduled 1 month later. The voltage map performed in sinus rhythm showed a low-voltage zone located at the anterolateral wall, near the previous ablation site. Numerous late potentials were recorded. At the 6-month follow-up, no further VT recurrences were documented after RF redo ablation.
While the speed of application and potential transmural effect can facilitate the ablation of large diseased endocardial areas, early loss of contact due to difficult pentaspline catheter manipulation in the LV could lead to insufficient contact force and, consequently, inadequate energy penetration.
由于其独特的特性，脉冲场消融（PFA）有可能克服当前射频（RF）室性心动过速（VT）消融的一些局限性。然而，目前关于该技术在这一领域应用的数据还很有限。
对两名患有缺血性心肌病且先前 RF VT 消融失败的患者进行了 PFA 治疗。
共对下外侧和下间隔区域（病例 1）和左心室（LV）心尖外侧壁（病例 2）进行了 18 次双极应用（病例 1）和 7 次双极应用（病例 2），将导管放置在 LV 壁旁的花形配置中。在两种情况下，在 PFA 输送过程中均观察到 VT 的快速终止和窦性心律的恢复。进一步的应用以实现晚期电位的完全消除。在病例 1 中，在住院期间，心电图监测未显示 VT 复发。6 个月的随访无事件发生，ICD 询问时无 VT 复发。在病例 2 中，由于出院后 VT 复发，计划在 1 个月后进行第二次 RF 手术。在窦性心律下进行的电压图显示，在前外侧壁，靠近先前消融部位，存在一个低电压区。记录到许多晚期电位。在 6 个月的随访中，RF 再次消融后未记录到进一步的 VT 复发。
虽然应用速度和潜在的贯穿效应可以促进大的病变心内膜区域的消融，但由于 LV 中 Pentaspline 导管难以操作，早期失去接触可能导致接触力不足，从而导致能量渗透不足。
