腔内结构起源的室性心律失常的脉冲场消融：来自一组临床病例的见解
Pulsed field ablation of ventricular arrhythmias arising from intracavitary structures: insights from a clinical case series.
作者信息
De Silva Kasun, So Tai Chung, Turnbull Samual, Bickley Max, Hashimoto Kenji, Bhaskaran Ashwin, Kumar Saurabh
机构信息
Department of Cardiology, Westmead Hospital, Corner Hawkesbury, and Darcy Roads, Sydney, NSW, 2145, Australia.
Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
出版信息
J Interv Card Electrophysiol. 2025 Jun 2. doi: 10.1007/s10840-025-02072-1.
INTRODUCTION
Premature ventricular complexes (PVCs) from intracavitary structures, such as papillary muscles and the moderator band, can be challenging to treat. Pulsed field ablation (PFA) offers a novel strategy for treating these arrhythmias.
METHODS
Between 2023 and 2024, three patients with intracavitary PVCs (two with PVC-mediated ventricular fibrillation) underwent PFA at a tertiary referral centre. Electroanatomic mapping was performed and, with intracardiac echocardiography (ICE) guidance, PFA was delivered using a pentaspline Farapulse catheter, with adjuvant radiofrequency (RF) ablation as needed.
RESULTS
All patients had successful abolition of PVCs. PFA delivery was feasible and safe, with excellent success despite prior RF ablation failures though one patient required adjuvant RF ablation. The only complication was a persistent right bundle branch block (RBBB) after PFA delivery to the moderator band. Follow-up showed significant reductions in PVC burden and no further ventricular fibrillation (VF) episodes. The mean procedural duration was 153.67 ± 31.71 min, and the mean fluoroscopy time was 14.38 ± 6.74 min.
CONCLUSION
This is a preliminary proof of concept report for ablation of PVCs from intracavitary structures, warranting further validation studies.
引言
来自心腔内结构（如乳头肌和节制索）的室性早搏（PVC）可能难以治疗。脉冲场消融（PFA）为治疗这些心律失常提供了一种新策略。
方法
在2023年至2024年期间，三名患有心腔内PVC的患者（两名患有PVC介导的心室颤动）在一家三级转诊中心接受了PFA治疗。进行了电解剖标测，并在心内超声心动图（ICE）引导下，使用五棱Farapulse导管进行PFA，并根据需要进行辅助射频（RF）消融。
结果
所有患者的PVC均成功消除。尽管先前RF消融失败，但PFA治疗是可行且安全的，成功率很高，不过有一名患者需要辅助RF消融。唯一的并发症是在对节制索进行PFA治疗后出现持续性右束支传导阻滞（RBBB）。随访显示PVC负荷显著降低，且无进一步的心室颤动（VF）发作。平均手术时间为153.67±31.71分钟，平均透视时间为14.38±6.74分钟。
结论
这是一篇关于消融心腔内结构PVC的初步概念验证报告，需要进一步的验证研究。
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