Pulsed field ablation of the premature ventricular contractions originating from the medial free wall of the right ventricular outflow tract infundibulum: a case report

Premature ventricular contractions (PVCs) originating from the infundibular region of the right ventricular outflow tract (RVOT) may be challenging to ablate due to thin myocardial wall and proximity to the coronary arteries in this region. In such anatomically sensitive regions, the use of radiofrequency (RF) energy may carry a risk of collateral injury or prove ineffective. We present a case report describing successful ablation of infundibular PVCs using pulsed field ablation (PFA).

A 38-year-old female with highly symptomatic, monomorphic PVCs was referred for repeat ablation following a previously ineffective procedure performed with RF energy. Intracardiac mapping localized the earliest ventricular activation to the medial free wall infundibulum of the RVOT. A series of high-power RF applications were delivered at the site of earliest activation; however, elimination of PVCs was not achieved. Given the ineffectiveness of RF ablation, the procedure was continued using PFA. A series of focal-bipolar PFA applications were delivered at the RVOT infundibulum target site. This resulted in complete elimination of PVCs. The procedure was completed without complications. At 4-month follow-up, the patient remained asymptomatic, and 24-h Holter monitoring confirmed the complete absence of PVCs.

This case demonstrates the feasibility of focal-bipolar PFA for PVCs arising from the RVOT infundibulum. Pulsed field ablation may offer a safe and effective alternative in anatomically challenging locations, particularly when conventional thermal energy sources are unsuccessful.