Dual-Modality Focal Ablation for Refractory Ventricular Summit Ectopy: First-in-Human Experience.

BACKGROUND

Catheter ablation at the left ventricular (LV) summit area has posed several challenges because of the complex architecture, the variable depths of the arrhythmia foci, and the proximity to the coronary vasculature. Several ablation methods have been proposed such as epicardial access, coronary venous alcohol infusion, or even hybrid surgical ablation, but the outcomes remain ill-defined.

CASE SUMMARY: A 53-year-old woman with frequent LV summit premature ventricular contractions (PVCs) presented to our institute for redo ablation due to PVC-induced cardiomyopathy. She had previously failed 2 prior ablations, including the epicardial approach during the second attempt. Due to the lack of other reasonable options, compassionate use of a novel dual-modality ablation catheter was pursued, which resulted in successful PVC suppression both acute and at short-term follow-up.

DISCUSSION: The case highlights the feasibility of the novel TactiFlex Duo catheter for treatment of refractory PVCs. This catheter enables dual-modality ablation including both radiofrequency and pulse field ablation. Energy delivery achieved adequate lesion penetration without any acute collateral damage, including coronary vasculature.

TAKE-HOME MESSAGES: Our case presents the first-in-human use of the novel TactiFlex Duo catheter combining, and underscoring the potential benefit of, radiofrequency/pulsed field ablation in ventricular ablation.