Focal pulsed field ablation of ventricular tachycardia in patients with structural heart disease: procedural characteristics, acute endpoints and early-to-midterm outcomes

BACKGROUND: Catheter ablation is an established therapy for ventricular tachycardia (VT) in structural heart disease (SHD), but radiofrequency ablation is limited by lesion depth and challenges in targeting intramural substrate. Pulsed field ablation (PFA) induces irreversible electroporation and may offer advantages for ventricular substrate modification. However, clinical data on focal PFA for VT remain limited. OBJECTIVE: To evaluate procedural characteristics, acute efficacy, safety, and outcomes of focal PFA for VT in patients with SHD. METHODS: In this single-center study, 16 consecutive patients with SHD underwent VT ablation using focal PFA. Acute success was defined as noninducibility of any sustained or nonsustained VT at the end of the procedure. VT recurrence during follow-up was assessed by implantable cardioverter-defibrillator interrogation and Holter monitoring. RESULTS: Mean age was 66±11 years, 9 (64%) patients had nonischemic cardiomyopathy, and mean left ventricular ejection fraction was 43±11%. Septal substrate was targeted in 11 (69%) patients. Mean procedure time was 138±34 minutes, with 58±26 PFA applications per case. Acute procedural success was achieved in 14 of 16 patients (88%). Major complications occurred in 1 patient (6%), who developed pericardial tamponade; no deaths, strokes, or myocardial infarctions occurred. During a median follow-up of 130 days, VT recurred in 3 patients, yielding 81% freedom from VT recurrence. CONCLUSION: Focal PFA for VT in SHD was feasible and was associated with high acute noninducibility and encouraging early freedom from VT recurrence, including in predominantly septal substrates. Larger studies are needed to define durability and optimal dosing strategies.