Focal pulsed field electroporation of left ventricular premature contractions after failed radiofrequency ablation

Pulsed field electroporation (PFE) has earned substantial attention owing to its unique, non–thermal tissue–preferential mechanism for cardiac ablation of arrhythmias and is used increasingly for pulmonary vein isolation.1, 2, 3 Recently, a pulsed electrical field delivery system consisting of a proprietary generator coupled to specified ablation catheters and 3D electroanatomical mapping systems obtained CE approval for pulmonary vein isolation in patients with paroxysmal atrial fibrillation based on results of the ECLIPSE trial.4 The utility of this system for mapping and ablation in human ventricular myocardium in the clinical setting of ventricular arrhythmias was recently reported in case form.5 In this case we present the first successful use of PFE for focal endocardial ablation of premature contractions from the left ventricle following extensive unsuccessful attempts at radiofrequency ablation (RFA) in the same procedure. Thus, in a direct intraprocedural comparison, focal PFE was superior to RFA, indicating a promising role for this ablation modality in the future treatment of ventricular arrhythmias.