Key result
Alternative ablation strategies like bipolar radiofrequency and pulsed field ablation offer potential for achieving transmurality in complex ventricular tachycardia, though clinical evidence is limited.
Why the study?
Alternative strategies are needed to overcome the limitations of conventional radiofrequency ablation, particularly achieving transmurality in complex or deep intramuscular substrates in ventricular tachycardia.
Do alternative ablation strategies (BRFA, PFA, ULTC, VEA, needle ablation) improve transmurality and outcomes in ventricular tachycardia compared to conventional unipolar radiofrequency ablation?
Do alternative ablation strategies (BRFA, PFA, ULTC, VEA, needle ablation) improve transmurality and outcomes in ventricular tachycardia compared to conventional unipolar radiofrequency ablation?
Alternative ablation technologies like bipolar RF, PFA, and ULTC offer promising mechanisms to achieve deeper, transmural lesions for complex ventricular tachycardia, but currently lack robust randomized clinical trial evidence.
Answers are grounded in this paper and cite their sources.
Should not yet change VT ablation practice; leaves open the role of alternatives pending randomized trials.
Catheter ablation remains a cornerstone in the treatment of ventricular tachycardia (VT) in structural heart disease. Part 1 of this review focused on the principles and technical aspects of radiofrequency (RF) ablation. Part 2 explores alternative strategies designed to overcome the limitations of conventional RF, in particular, achieving transmurality in complex or deep intramuscular substrates. We critically evaluate the mechanisms, evidence and clinical applications of bipolar RF ablation, pulsed-field ablation (PFA), ultra-low-temperature cryoablation (ULTC) and venous ethanol and needle ablation. Despite the rapid expansion ofthe technological armamentarium, current clinical evidence remains limited. The data supporting long-term safety and durability are predominantly based on preclinical and small observational studies. We advocate for continued investigation into these specialised techniques to provide a more tailored, patient-specific approach to VT management.
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Niespialowska-Steuden et al. (2026) conducted a review in Ventricular Tachycardia. Alternative ablation strategies (BRFA, PFA, ULTC, VEA, needle ablation) was evaluated. Alternative ablation strategies like bipolar radiofrequency and pulsed field ablation offer potential for achieving transmurality in complex ventricular tachycardia, though clinical evidence is limited.
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