Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy: Is Pulsed Field Ablation the Next Paradigm Shift?

Ventricular tachycardia ablation in nonischemic cardiomyopathy remains limited by high recurrence rates despite advances in catheter-based techniques. In nonischemic cardiomyopathy, the arrhythmogenic substrate is often heterogeneous and may involve intramural or epicardial myocardium, making durable lesion formation with conventional thermal energy difficult. Pulsed field ablation uses irreversible electroporation rather than thermal injury and is being investigated as an alternative approach for these challenging substrates. Early preclinical and clinical experience has shown encouraging results, with no major safety concerns identified so far. This review examines the current challenges of thermal ventricular tachycardia ablation, summarizes the current evidence for pulsed field ablation in this group of patients, and highlights knowledge gaps and future directions.