Non-endocardial radiofrequency ablation of premature ventricular complexes (NERA-PVC): safety, efficacy and outcome

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency ablation (RF) is a well-established treatment for premature ventricular complexes (PVCs) It not uncommon to perform radiofrequency PVCs arising from epicardial/intramural localization, in particular those the LV summit and aortic sinuses Valsalva. Purpose The aim investigate safety, efficacy, outcome through non-endocardial approach including high power long duration RF applications. Methods We defined Non-Endocardial Ablation (NERA) procedure which at least one site has been identified into coronary venous system, Valsalva, inter-leaflet triangle or pulmonary cusps. selected study population series consecutive patients who underwent January 2017-May 2022, whom application realized according definition. Results During period, 399 46 fulfilled inclusion criteria (age: 59±13 years; 33, 72% males; mean LVEF:46±12%, PVC burden 26±10 %). total number NERA sites was 55: 15(27%) 9(16%) right cusp, 10(18%) left 18 (33%) interleaflet between cusp 3 (5%) cusp. In (39%) multisite performed. Mean during 37±9 W (15-50) with median 40W. single 88±72 seconds (30-304) (median: 58 seconds). 63% (40W more) 55% (>60 seconds) delivered spots. Procedural success achieved 37 (80%). No complications related were observed. Multisite significantly associated procedural failure (OR 8,27; CI 1,48– 46,31; p=0,01). follow up, 7,3±9%, reduction (Δ) 69±41% 96%. rate event-free survival 69%. system predictors recurrence (HR 3,81; 95% 1,14–12,66; p=0,02 HR 3,88; 1,23 – 12,27; p=0,01), while protective 0.1; 0.03 - 0.33, p < 0.001). After multivariate Cox proportional hazard analysis, higher VA recurrences up 2.71, 0.83 8.85, p= 0,09), confirmed his role 0.13, 0.04-0.42, 0,001). Conclusion safe effective procedure, even using and/or RF. Nevertheless term outcomes are still characterized by than purely endocardial ablation.