First United States Experience With Focal Pulsed-Field Ablation Using the FARAPOINT Catheter for Refractory Ventricular Tachycardia.

BACKGROUND

Drug-refractory ventricular tachycardia (VT) after failed radiofrequency (RF) ablation remains a clinical challenge. Pulsed-field ablation (PFA) is expanding to ventricular applications, but United States experience with focal pulsed-field-only catheters in VT is sparse, and pulsed-field platforms are not equivalent across manufacturers. Here we describe the first United States experience of FARAPOINT focal PFA in patients with refractory VT.

METHODS AND

RESULTS

We retrospectively reviewed ten consecutive patients who underwent VT ablation with the FARAPOINT (Boston Scientific) focal PFA catheter at a single VA Health Care System between July 2025 and May 2026. All patients had drug-refractory sustained monomorphic VT. Median age was 77 years with a mix of ischemic and nonischemic cardiomyopathy. Six of ten had at least one prior failed catheter ablation. Acute non-inducibility was achieved in all nine patients who underwent formal post-ablation stimulation testing. No procedural complications occurred. Over a median follow-up of 95.5 days, sustained VT recurred in four of ten patients. No patient underwent repeat ablation, required mechanical circulatory support, or died.

CONCLUSIONS

In this initial United States experience, FARAPOINT was safe and acutely effective in patients with ischemic cardiomyopathy within a high-risk cohort with refractory VT and prior failed ablations, including challenging substrates. Prospective multicenter studies are warranted to expand these observations.