Pulsed-field ablation for ventricular tachycardia and premature ventricular contractions: an updated systematic review and meta-analysis

Abstract Background Pulsed-field ablation (PFA) is an emerging non-thermal energy modality that induces irreversible electroporation, selectively affecting myocardial cells while sparing surrounding tissue. It has shown promise in treating atrial arrhythmias and is now being explored for ventricular arrhythmias. This updated systematic review and meta-analysis evaluates the acute efficacy of PFA in managing both ventricular tachycardia (VT) and premature ventricular contractions (PVCs), expanding on previous evidence. Methods We searched PubMed, Embase, Scopus, and Web of Science for studies reporting PFA outcomes in VT and/or PVCs up to 12 October 2025. Two independent reviewers performed the screening, selection, and data extraction processes of studies that evaluated the safety and efficacy of PFA in VT/PVC management . Acute success rates were pooled separately for VT and PVC using random effect models. Sensitivity analysis was performed excluding case reports. All analyses were performed using R software (version 4.4.1). Results Twenty-six studies with total sample size of 113 patients were included in the analysis. In total, 110 patients underwent PFA, including 50 VT patients and 60 PVC patients, with a male-to-female ratio of approximately 2:1. The pooled acute success rate for VT ablation was 90% (95% CI: 78–96%; Figure 1, Panel A), and 86% (95% CI: 70–94%; Figure 1, Panel B) after excluding case reports. For PVC ablation, the pooled success rate was 85% (95% CI: 74–92%; Figure 1, Panel C), and 84% (95% CI: 73–92%; Figure 1, Panel D) in sensitivity analysis. Only three procedural complications were reported across all studies. Conclusion Pulsed-field ablation appears to be a promising technique for the treatment of ventricular arrhythmias, demonstrating high acute success rates and a low complication profile. It may serve as a valuable alternative to conventional ablation methods, but further prospective studies with larger populations are necessary to establish its long-term safety and efficacy. a