Pulse Field Ablation for Refractory Ventricular Tachycardia in a Patient With LVAD: Safety and Feasibility.

BACKGROUND

Ventricular tachycardia (VT) increases mortality in advanced heart failure. Pulsed field ablation (PFA) can offer an alternative method for VT ablation.

CASE SUMMARY: A 63-year-old man with advanced heart failure and left ventricular assist device (LVAD) presented with recurrent VT and implantable cardioverter-defibrillator therapies. After 2 previous radiofrequency VT ablations, his third VT ablation combined radiofrequency with PFA.

DISCUSSION: PFA represents a promising alternative to thermal ablation techniques. In our case, PFA was performed safely in a patient with an LVAD, yet it also revealed certain limitations of the current technology. Although studies in atrial fibrillation have yielded encouraging results, using PFA for VT requires further investigation to confirm both safety and efficacy, particularly regarding adequate pulse delivery to produce transmural lesions in the ventricular myocardium.

TAKE-HOME MESSAGES: PFA can be used for VT ablation in patients with LVADs. Further studies are required to elucidate its effectiveness and safety.