Ventricular pulsed field ablation demonstrated high pooled acute success (93% for PVC and 89% for VT in ≥3-patient cohorts) and acceptable near-term safety.
Meta-Analysis (n=355)
Yes
Does ventricular pulsed field ablation provide acute effectiveness, safety, and mid-term durability in patients with premature ventricular complexes or ventricular tachycardia?
Ventricular pulsed field ablation demonstrates high acute effectiveness and acceptable near-term safety for PVC and VT, though current evidence is limited by small study sizes and heterogeneity.
Abstract Background Ventricular pulsed field ablation (PFA) is increasingly adopted for premature ventricular complexes (PVC) and ventricular tachycardia (VT), yet the evidence base remains fragmented. We summarised acute effectiveness, ≤30-day safety, and mid-term recurrences from clinical studies. Purpose To pool outcomes of ventricular PFA across indications (PVC, VT), estimate between-study heterogeneity, and test robustness in analyses restricted to cohorts with ≥3 patients. Methods We performed a systematic review and meta-analysis of clinical reports to 8 September 2025. Primary endpoints were: (1) acute success (PVC: elimination of the clinical focus at procedure end; VT: non-inducibility at procedure end), (2) intra/≤30-day complications, and (3) recurrence incidence (events per patient-year) at longest follow-up. Proportions were synthesised with generalised linear mixed models (logit link; REML). Recurrence was modelled using mixed-effects Poisson models with a person-time offset. Overlapping reports were de-duplicated at patient level; a prespecified sensitivity included only cohorts with ≥3 patients. Heterogeneity was expressed as I² (and prediction intervals when informative). Results 355 patients (PVC 122, VT 233) from 43 studies were included; mean age 59.3±14.8 years. Mean LVEF was 53.9±11.7% in PVC and 34.8±12.6% in VT. Redo procedures in 43% of all index PFA sessions. Main etiology was ischemic cardiomyopathy in VT group (51%) and idiopahtic in PVC group (72%). Mean follow-up was ~5 months (PVC 155±79 days; VT 152±44 days). Six distinct PFA ablation systems were identified across studies. Hybrid workflows (PFA+RF) occurred in 38%. On average, JBI risk of bias ratings were moderate. (1)Acute effectiveness: In ≥3-patient cohorts, pooled success was 93% (95% CI 85–99; I²=0%) for PVC and 89% (95% CI 83–93; I²=0%) for VT. When all studies were pooled, estimates were ≈100% (PVC) and ≈99% (VT), with I²=0% for both, consistent with small-study/publication effects. (2)Safety (≤30 days): In ≥3-patient cohorts, complications were 8% (95% CI 1–21; I²≈47%) for PVC and 10% (95% CI 5–15; I²=0%) for VT. Across all studies, model-based pooled proportions were ≈1% with I²=0% in both indications. Aggregated counts showed 35/355 complications (9.8%) and 6/355 deaths (1.6%), all in VT. (3)Recurrence: Incidence was 0.33 events/patient-year for PVC (I²=0%) and 0.40–0.44 for VT, with modest heterogeneity for VT (I²≈28% in ≥3-patient analyses); the VT prediction interval was ≈0.19–1.25 events/patient-year, reflecting variability in substrate, approach, and surveillance. Conclusion Across heterogeneous platforms and workflows, ventricular PFA demonstrates high acute effectiveness, acceptable near-term safety, and consistent mid-term durability. Estimates restricted to ≥3 patients studies appear more generalisable than all-study pools and suggest small-study effects. Comparative studies and registries with standardised endpoints are warranted.PRISMA 2020 flow diagram
Finori et al. (Mon,) conducted a meta-analysis in Premature ventricular complexes (PVC) and ventricular tachycardia (VT) (n=355). Ventricular pulsed field ablation (PFA) was evaluated on Acute success (PVC: elimination of the clinical focus at procedure end; VT: non-inducibility at procedure end). Ventricular pulsed field ablation demonstrated high pooled acute success (93% for PVC and 89% for VT in ≥3-patient cohorts) and acceptable near-term safety.