Pulsed field ablation for ventricular arrhythmias: From mechanistic foundations to clinical translation

Ventricular arrhythmias (VAs), particularly scar-related ventricular tachycardia, remain a leading cause of sudden cardiac death in patients with structural heart disease. Although radiofrequency ablation is the current standard of care, its efficacy is limited in complex myocardial substrates. Pulsed field ablation (PFA), a non-thermal and cell-selective technique based on irreversible electroporation, has emerged as a promising alternative. This review provides a comprehensive overview of the mechanistic rationale, preclinical validation, and early clinical experiences of PFA in VAs. It primarily discusses potential challenges in the clinical treatment of ventricular tachycardia. Furthermore, we highlight emerging catheter systems and the possible synergistic value of functional substrate mapping, preprocedural imaging, and parameter optimization in improving the precision and safety of PFA. As a promising ablation technology, PFA holds strong potential for treating VAs.