Pulse Field Ablation for Refractory Ventricular Tachycardia in a Patient With LVAD

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Refractory Ventricular Tachycardia (n=1). Intervention: Pulsed field ablation (PFA). Primary outcome: Safety and feasibility of PFA with LVAD support, and elimination of ventricular tachycardia.

Q: What does this research mean for the field?

Pulsed field ablation combined with radiofrequency can be safely performed for refractory ventricular tachycardia in patients with a left ventricular assist device, though current technology has limitations regarding transmural lesion creation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Gabriel Velez Oquendo; Shivani Mehta; Riaz Mahmood; Ugochukwu Egolum; Shalabh Chandra

doi:10.1016/j.jaccas.2025.106338

December 3, 2025JACC Case ReportsOpen Access

Pulse Field Ablation for Refractory Ventricular Tachycardia in a Patient With LVAD

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Key result

Pulsed field ablation proves safe with LVAD support but fails to eliminate refractory VT.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Ventricular tachycardia increases mortality in advanced heart failure, and pulsed field ablation may offer an alternative method for ventricular tachycardia ablation.

Does pulsed field ablation safely treat refractory ventricular tachycardia without causing interference in a patient with a left ventricular assist device?

Study Design

Type

Case Report (n=1)

Structured PICO

Does pulsed field ablation safely treat refractory ventricular tachycardia without causing interference in a patient with a left ventricular assist device?

P

Population

A 63-year-old man with advanced heart failure and an LVAD who presented with recurrent ventricular tachycardia despite multiple previous ablations.

I

Intervention

Pulsed field ablation (53 lesions using Farapulse catheter in olive, basket, and flower formats) combined with radiofrequency ablation for substrate modification.

O

Outcome

Safety and feasibility of pulsed field ablation in a patient with a left ventricular assist device (LVAD function and interference).safety

Pulsed field ablation can be safely applied for ventricular tachycardia substrate modification in patients with an LVAD without causing device interference, though specialized ventricular catheters and pulse algorithms are needed for optimal efficacy.

Limitations

Lack of transmural ablation with PFA in the ventricular myocardium.
Difficult myocardial contact because current delivery systems are designed for the atrium.
Patient's VT circuit was likely intramyocardial and/or epicardial and not entirely treatable by endocardial ablations only.
Findings based on a single case report cannot be generalized.
Single case report
Current PFA delivery systems are designed for the atrium, leading to limited left ventricular apical reach and difficult catheter contact
Lack of optimized PFA pulse delivery algorithms to ensure adequate transmural lesions in the ventricular myocardium

Implication

May allow safe pulsed field ablation near active LVADs; leaves open efficacy and need for optimized ventricular systems.

Abstract

BACKGROUND: Ventricular tachycardia (VT) increases mortality in advanced heart failure. Pulsed field ablation (PFA) can offer an alternative method for VT ablation. CASE SUMMARY: A 63-year-old man with advanced heart failure and left ventricular assist device (LVAD) presented with recurrent VT and implantable cardioverter-defibrillator therapies. After 2 previous radiofrequency VT ablations, his third VT ablation combined radiofrequency with PFA. DISCUSSION: PFA represents a promising alternative to thermal ablation techniques. In our case, PFA was performed safely in a patient with an LVAD, yet it also revealed certain limitations of the current technology. Although studies in atrial fibrillation have yielded encouraging results, using PFA for VT requires further investigation to confirm both safety and efficacy, particularly regarding adequate pulse delivery to produce transmural lesions in the ventricular myocardium. TAKE-HOME MESSAGES: PFA can be used for VT ablation in patients with LVADs. Further studies are required to elucidate its effectiveness and safety.

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Cite This Study

Oquendo et al. (2025) conducted a case report in Refractory Ventricular Tachycardia (n=1). Pulsed field ablation (PFA) was evaluated on Safety and feasibility of PFA with LVAD support, and elimination of ventricular tachycardia. Pulsed field ablation was performed safely without disrupting LVAD function in a patient with refractory ventricular tachycardia, although the patient ultimately remained in VT.

synapsesocial.com/papers/6a15c064d64fa33389a0052f https://doi.org/10.1016/j.jaccas.2025.106338