Single very high-power short-duration application for successful ablation of frequent premature ventricular contractions

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The concept of very high-power short-duration (vHP-SD) was found to be safe, effective, and fast for atrial catheter ablation (CA). No evaluation of vHP-SD has been performed for ventricular procedures in human up to date. A 39-year-old patient presented with frequent monomorphic premature ventricular contractions (PVC) with an inferior axis and an RS transition in V2/V3, highly suggestive of a right ventricular outflow tract (RVOT) origin. Three-dimensional electroanatomic reconstruction (CARTO 3 V7; Biosense Webster) of the right ventricle (RV) was performed via fast anatomical mapping with a linear decapolar mapping catheter (DECANAV; Biosense Webster). The earliest activation was detected within the antero-lateral RVOT. The novel QDOT Micro ablation catheter (Biosense Webster) was utilized for CA. This catheter provides three microelectrodes and six thermocouples and allows for vHP-SD ablation (90 W/4 s). Within the antero-lateral RVOT, the microelectrodes detected early fragmented potentials which were not detectable on the standard bipolar electrodes. A single vHP-SD application of 4 s was performed resulting in an immediate loss of PVC. The total procedure time was 68 min. No periprocedural complications occurred. Here, we are presenting the first-in-man treatment of frequent PVC originating from RVOT by ablation with a single vHP-SD application.

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