Preliminary experience on dual-energy ablation for ventricular tachycardia

Background Ventricular tachycardia (VT) in patients with structural heart disease remains a major cause of morbidity and mortality. Although catheter ablation represents a cornerstone treatment, its efficacy can be limited by insufficient lesion depth and intramural substrates. Novel catheters using dual-energy radiofrequency and pulse field delivery, such as dual energy nitinol-lattice sphere catheter and dual energy focal contact-force (CF) catheter, have been developed to optimize lesion homogeneity and procedural outcomes. Clinical data comparing these tools in real-world VT ablation remain limited. Purpose To assess the safety and efficacy of VT ablation performed with dual-energy catheters in a consecutive single-centre population. Methods Fifteen consecutive male patients (mean age 59 ± 18 years, BMI 27 ± 3 kg/m², LVEF 37 ± 9 %) underwent VT ablation between April 2025 and October 2025. Ischaemic cardiomyopathy was present in 40 % and structural heart disease in 60 %; 40 % had prior ablation and 40 % presented with electrical storm. All procedures were performed under general anaesthesia using 3D electroanatomical mapping. Dual energy nitinol-lattice sphere catheter were used in 8 patients (53 %) and dual energy focal CF catheter in 7 (47 %), according to operator preference and substrate characteristics. Endocardial ablation was performed in all cases, with also an epicardial access in 3 (20 %). Primary endpoint was acute success, defined as post-ablation non-inducibility of VT. Secondary endpoints included procedural safety and VT recurrence during hospitalization. Results Acute success was achieved in 11 of 15 patients (73.3 %). Three procedures (20 %) required epicardial mapping. Mean procedural time was 211 ± 66 min, with a mean fluoroscopy time of 28 ± 11 min. Mean RF applications was 59 ± 33 min, with a mean PF applications of 56 ± 33 min. Major complications occurred in 1 patients consist in tamponande resolved with periocardiocentesis. 5 patients (33.3 %) experienced VT recurrence during hospitalization, while 10 (66.7 %) remained arrhythmia-free. All patients had an implantable cardioverter-defibrillator, and no electrical storms recurred post-procedure. Conclusions In this initial single-centre experience, VT ablation using dual-energy catheter, either dual energy nitinol-lattice sphere catheter or dual energy focal CF catheter, proved to be safe and effective, achieving a high acute success rate with minimal complications. These encouraging preliminary data support the feasibility of dual-energy VT ablation in daily clinical practice, but larger prospective studies are warranted to validate the long-term safety and efficacy of dual-energy systems.