Focal pulsed field ablation for complex ventricular arrhythmias after prior failed or intraprocedurally ineffective radiofrequency ablation.

BACKGROUND

Pulsed field ablation (PFA) has emerged as a novel non-thermal energy source for catheter ablation. While its use in atrial arrhythmias has expanded rapidly, clinical experience with ventricular PFA remains limited.

OBJECTIVE

This study aimed to evaluate the feasibility, safety, and clinical outcomes of focal PFA for the treatment of complex ventricular arrhythmias.

METHODS

This single-center observational study included patients undergoing catheter ablation for ventricular arrhythmias using focal PFA. The study population consisted of patients with challenging arrhythmia substrates, including redo procedures and cases requiring an intraprocedural switch from conventional radiofrequency ablation to focal PFA as a bail-out strategy. Acute procedural success, complications, and arrhythmia recurrence during follow-up were assessed.

RESULTS

A total of 20 patients underwent ventricular PFA. Acute procedural success, defined as elimination of the target premature ventricular complex or noninducibility of sustained monomorphic ventricular tachycardia, was achieved in 95% of cases. During a mean follow-up of 663 ± 318 days, arrhythmia recurrence occurred in 10 patients (50%), including 6 of 9 (67%) with ventricular tachycardia and 4 of 11 (36%) with premature ventricular complexes. The overall complication rate was 15%, including one major vascular complication and two minor complications.

CONCLUSION

Focal PFA demonstrated high acute procedural success and an acceptable safety profile in complex ventricular arrhythmias. These findings support its feasibility as an additional energy modality in challenging substrates. Larger prospective studies are needed to further define its role and long-term efficacy.