Focal pulsed field ablation of septal ventricular tachycardia in structural heart disease: a fast and effective approach

Background Ventricular tachycardia (VT) arising from the interventricular septum in patients with structural heart disease represents a challenging ablation target. Pulsed field ablation (PFA) offers potential advantages including shorter procedure times and deeper tissue penetration, which is particularly relevant for septal VT. Purpose To assess the efficacy and efficiency of focal pulsed field ablation for drug-refractory septal VT in structural heart disease. Methods We performed focal PFA in eight consecutive patients with structural heart disease (ischemic cardiomyopathy 25%, non-ischemic cardiomyopathy 75%) and septal VT. Mean age was 70±10 years. Focal monopolar PFA was delivered at 25 ampere via endocardial approach. Results Acute procedural success was achieved in 100% of patients (8/8). Mean procedure time was 118±35 minutes, demonstrating procedural efficiency. Mean number of PFA applications was 59±17. During 3-month follow-up, one patient developed slower VT. One pericardial tamponade occurred as a major complication. Conclusions In this high-risk population with structural heart disease and septal VT, focal pulsed field ablation demonstrates excellent effectiveness with notably short procedure times, supporting its role as a valuable ablation modality for this therapeutically challenging patient subgroup.