Utilization of Large Lattice-Tip Dual Energy Catheter for Left Ventricular Summit Arrhythmia Ablation

Ventricular arrhythmias arising from the left ventricular (LV) summit are technically challenging to ablate because of limited accessibility and proximity to the coronary arteries. Dual energy lattice-tip catheter (DLTC) could provide both very high-power temperature-controlled radiofrequency (RF) ablation and pulse field (PF) ablation. To describe the use of combined radiofrequency (RF) and pulsed field (PF) ablation using a dual-energy large lattice-tip catheter for treatment of ventricular tachycardia originating from the LV summit region. We report a 66-year-old man with atrial fibrillation, heart failure with reduced ejection fraction, and recurrent VT despite prior endocardial and epicardial radiofrequency ablation. Mapping localized the PVC/VT to a LV summit–adjacent region, with an endocardial target along the superior septum/LVOT consistent with an intramural or epicardial summit substrate. Given prior failed RF ablations compassionate-use ablation with the dual-energy lattice-tip catheter and Affera™ mapping system (Medtronic, Minneapolis, MN) was performed under intracardiac echocardiogram guidance. Interventional cardiology was directly involved, providing coronary angiography and intravascular imaging before and after ablation to ensure the absence of vasospasm or ischemia. At 6 week follow up, following dual-energy ablation with DLTC, there was significant suppression of ventricular arrhythmia off antiarrhythmic amiodarone. There was no evidence of coronary injury post ablation confirmed by coronary angiogram and intravascular ultrasound. This case highlights the feasibility of high-power temperature controlled-RFA and focal PFA for VT in anatomically regions where success with conventional energy sources is limited. Combined RF and PF ablation using the DLTC achieved safe and effective ablation of LV summit ventricular tachycardia without coronary injury.