Pulsed field ablation for premature ventricular contractions: a systematic review and meta- analysis of safety, acute and mid-term outcomes

Background

Pulsed field ablation (PFA) has emerged as a non-thermal ablation technology capable of producing myocardial lesions while minimizing collateral tissue injury. Although extensively studied in atrial fibrillation, evidence regarding its role in ventricular arrhythmias - particularly premature ventricular contractions (PVCs) - remains limited to small observational cohorts.

Purpose

To evaluate the safety and acute and mid-term procedural success of PFA and the incidence of early complications in patients undergoing PVCs ablation.

Methods

A comprehensive search of PubMed, Embase, and the Cochrane Library was performed for studies of PVC ablation using PFA that reported ablation success and complications. Case reports were excluded. Six observational cohort studies were eligible. A single-arm meta-analysis was conducted in R using a random-effects model with Freeman-Tukey double arcsine transformation.

Primary endpoints were acute success (PVC elimination) and mid-term success (persistent PVC suppression at follow-up).

Results

The total cohort included 107 patients (mean age 55 ± 15 years, 50% male), of whom 33% had undergone prior unsuccessful ablation using thermal energy. PVCs originated most commonly from the right (36%) and left (21%) ventricular outflow tract and the mean pre-procedural PVCs burden was 20 ± 11%. Acute procedural success was achieved in 85% (95% CI 72.3-94.0, I² = 50%) of patients. During a follow-up of 5.2 ± 3.7 months 79% of patients (95% CI 70.2-86.7, I² = 0%) remained free of PVCs (Figure 1). Transient coronary vasospasm and conduction system abnormalities occurred in 2.4% (95% CI 0.0-7.2, I² = 0%) and 7.3% (95% CI 1.9-14.8, I² = 0%) respectively, other complications were 2% (95% CI 0.0-6.8; I² = 0%)(Figure 2).

Conclusion

Pulsed field ablation demonstrates high acute and mid-term success rates of eliminating PVCs, even in previously failed ablations, and acceptable complication rates in early observational studies. Larger prospective studies and randomized controlled trials are required to establish the long-term efficacy, safety profile, and optimal procedural strategies for the treatment of ventricular arrhythmias with PFA.