Scar-related ventricular tachycardia ablation using a dual-energy lattice-tip ablation system guided by pre-procedural imaging

Introduction Catheter ablation for scar-related ventricular tachycardia (VT) remains challenging due to limitations in ventricular mapping and the need for deeper lesions to eliminate intramural conduction channels. Aim To evaluate the feasibility, safety, and acute efficacy of a structured multimodal planning strategy combined with a hybrid high-energy ablation protocol for scar-related VT. Methods We prospectively studied consecutive patients undergoing endocardial VT ablation guided by pre-procedural imaging integration. Multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) were segmented and co-registered into the mapping system to prioritize zones of interest. A standardized hybrid protocol—radiofrequency followed by pulsed-field ablation at each site—was applied. Acute success was defined as complete elimination of local abnormal ventricular activity (LAVA) and VT non-inducibility. Results Nineteen patients (mean age 68 ± 8 years; 74% ischemic cardiomyopathy; 63% VT storm) were included. Imaging predicted LAVA-bearing segments with sensitivity/specificity of 80%/85% for MDCT and 67%/75% for LGE-CMR. Complete LAVA abolition was achieved in 94.7% of patients, and VT non-inducibility in 73.7%. One major vascular complication occurred; no deaths or cardiac perforations were observed. After a median follow-up of 106 days, VT recurrence occurred in 10.5% of patients. Conclusion A structured imaging-guided workflow combined with hybrid RF–PFA ablation is feasible and safe, achieving high acute success in scar-related VT. Further studies should confirm long-term outcomes and optimize energy delivery parameters.