AIMS: Catheter ablation is an effective treatment method for recurrent ventricular tachycardias (VTs). However, at least in part, procedural and clinical outcomes are limited by challenges in generating an adequate lesion size in the ventricular myocardium. We investigated procedural and clinical outcomes of VT ablation using a novel 'large-footprint' catheter that allows the creation of larger lesions either by radiofrequency (RF) or by pulsed field (PF) energy. METHODS AND RESULTS: In prospectively collected case series, we describe our initial experience with VT ablation using a lattice-tip, dual-energy catheter (Sphere-9, Medtronic), and a compatible proprietary electroanatomical mapping system (Affera, Medtronic). The study population consisted of 18 patients (aged 55 ± 15 years, one woman, structural heart disease: 94%, ischaemic heart disease: 56%, left ventricular ejection fraction: 34 ± 10%, electrical storm: 22%) with recurrent sustained VTs and ≥1 previously failed endocardial RF ablation with conventional irrigated-tip catheter in 66% of patients. On average, 12 ± 7 RF and 8 ± 9 PF applications were delivered per patient. In three-fourths of patients undergoing percutaneous epicardial ablation, spasms in coronary angiography were observed after PF applications. All resolved after intracoronary administration of nitrates. No acute phrenic nerve palsy was noted. One patient suffered from a stroke that resolved without sequelae. Post-ablation non-inducibility of VT was achieved in 89% of patients. Ventricular-arrhythmia-free survival at three months was 78%. CONCLUSION: VT ablation using a dual-energy lattice-tip catheter and a novel electroanatomical mapping system is feasible. It allows rapid mapping and effective substrate modification with good outcomes during short-term follow-up.

Cardiac Ablation Solutions Medtronic Minneapolis MN USA

Department of Cardiology IKEM Vídeňská 1958 9 Prague 140 00 Czechia

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Zeppenfeld  K, Tfelt-Hansen  J, de Riva  M, Winkel  BG, Behr  ER, Blom  NA  et al.  2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J  2022;40:3997–4126. PubMed

Natale  A, Zeppenfeld  K, Della Bella  P, Liu  X, Sabbag  A, Santangeli  P  et al.  Twenty-five years of catheter ablation of ventricular tachycardia: a look back and a look forward. Europace  2023;25:euad225. PubMed PMC

Ravi  V, Poudyal  A, Khanal  S, Khalil  C, Vij  A, Sanders  D  et al.  A systematic review and meta-analysis comparing radiofrequency catheter ablation with medical therapy for ventricular tachycardia in patients with ischemic and non-ischemic cardiomyopathies. J Interv Card Electrophysiol  2023;66:161–75. PubMed

Della Bella  P, Baratto  F, Vergara  P, Bertocchi  P, Santamaria  M, Notarstefano  P  et al.  Does timing of ventricular tachycardia ablation affect prognosis in patients with an implantable cardioverter defibrillator? Results from the multicenter randomized PARTITA trial. Circulation  2022;145:1829–38. PubMed

Anter  E, Mansour  M, Nair  DG, Sharma  D, Taigen  TL, Neuzil  P  et al.  Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial. Nat Med  2024;30:2303–10. PubMed PMC

Kitamura  T, Hocini  M, Bourier  F, Martin  R, Takigawa  M, Frontera  A  et al.  Larger and deeper ventricular lesions using a novel expandable spherical monopolar irrigated radiofrequency ablation catheter. J Cardiovasc Electrophysiol  2019;30:1644–51. PubMed

Shapira-Daniels  A, Barkagan  M, Yavin  H, Sroubek  J, Reddy  VY, Neuzil  P  et al.  Novel irrigated temperature-controlled lattice ablation catheter for ventricular ablation. Circ Arrhythm Electrophysiol  2019;12:e007661. PubMed PMC

Nies  M, Watanabe  K, Kawamura  I, Santos-Gallego  CG, Reddy  VY, Koruth  JS. Preclinical study of pulsed field ablation of ‘difficult’ ventricular targets: intracavitary mobile structures, interventricular septum and left ventricular free wall. Circ Arrhythm Electrophysiol  2024;17:e012734. PubMed PMC

Yokoyama  M, Vlachos  K, Duchateau  J, Sacher  F, Jaïs  P, Tixier  R. Pulsed field epicardial ablation for VT storm: a case report of bail-out therapy. Heart Rhythm  2024. doi:10.1016/j.hrthm.2024.08.021. Online ahead of print. PubMed DOI

Pannone  L, Doundoulakis  I, Cespón-Fernández  M, Eltsov  I, Chierchia  GB, de Asmundis  C  et al.  A large footprint focal catheter toggling between pulsed field and radiofrequency energy: first clinical experience for ventricular tachycardia ablation. Europace  2024;26:euae193. PubMed PMC

Sosa  E, Scanavacca  M, d’Avila  A, Pilleggi  F. A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol  1996;7:531–6. PubMed

Peichl  P, Wichterle  D, Pavlu  L, Cihak  R, Aldhoon  B, Kautzner  J. Complications of catheter ablation of ventricular tachycardia: a single-center experience. Circ Arrhythm Electrophysiol  2014;7:684–90. PubMed

Barkagan  M, Leshem  E, Rottmann  M, Sroubek  J, Shapira-Daniels  A, Anter  E. Expandable lattice electrode ablation catheter: a novel radiofrequency platform allowing high current at low density for rapid, titratable, and durable lesions. Circ Arrhythm Electrophysiol  2019;12:e007090. PubMed PMC

Yavin  HD, Higuchi  K, Sroubek  J, Younis  A, Zilberman  I, Anter  E. Pulsed-field ablation in ventricular myocardium using a focal catheter: the impact of application repetition on lesion dimensions. Circ Arrhythm Electrophysiol  2021;14:e010375. PubMed

Im  SI, Higuchi  S, Lee  A, Stillson  C, Buck  E, Morrow  B  et al.  Pulsed field ablation of left ventricular myocardium in a swine infarct model. JACC Clin Electrophysiol  2022;8:722–31. PubMed

Younis  A, Buck  E, Santangeli  P, Tabaja  C, Garrott  K, Lehn  L  et al.  Efficacy of pulsed field vs radiofrequency for the reablation of chronic radiofrequency ablation substrate: redo pulsed field ablation. JACC Clin Electrophysiol  2024;10:222–34. PubMed

Sandhu  U, Alkukhun  L, Kheiri  B, Hodovan  J, Chiang  K, Splanger  T  et al.  In vivo pulsed-field ablation in healthy vs. chronically infarcted ventricular myocardium: biophysical and histologic characterization. Europace  2023;25:1503–9. PubMed PMC

Nakagawa  H, Castellvi  Q, Neal  R, Girouard  S, Laughner  J, Ikeda  A  et al.  Effects of contact force on lesion size during pulsed field catheter ablation: histochemical characterization of ventricular lesion boundaries. Circ Arrhythm Electrophysiol  2024;17:e012026. PubMed

Peichl  P, Bulava  A, Wichterle  D, Schlosser  F, Stojadinović  P, Borišincová  E  et al.  Efficacy and safety of focal pulsed-field ablation for ventricular arrhythmias: two-centre experience. Europace  2024;26:euae192. PubMed PMC

Stojadinović  P, Wichterle  D, Peichl  P, Nakagawa  H, Čihák  R, Hašková  J  et al.  Autonomic changes are more durable after radiofrequency than pulsed electric field pulmonary vein ablation. JACC Clin Electrophysiol  2022;8:895–904. PubMed

Ekanem  E, Neuzil  P, Reichlin  T, Kautzner  J, van der Voort  P, Jais  P  et al.  Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study. Nat Med  2024;30:2020–9. PubMed PMC

Reddy  VY, Petru  J, Funasako  M, Kopriva  K, Hala  P, Chovanec  M  et al.  Coronary arterial spasm during pulsed field ablation to treat atrial fibrillation. Circulation  2022;146:1808–19. PubMed

Higuchi  S, Im  SI, Stillson  C, Buck  ED, Jerrell  S, Schneider  CW  et al.  Effect of epicardial pulsed field ablation directly on coronary arteries. JACC Clin Electrophysiol  2022;8:1486–96. PubMed

Gökoğlan  Y, Mohanty  S, Gianni  C, Santangeli  P, Trivedi  C, Güneş  MF  et al.  Scar homogenization versus limited-substrate ablation in patients with nonischemic cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol  2016;68:1990–8. PubMed

Tzou  WS, Frankel  DS, Hegeman  T, Supple  GE, Garcia  FC, Santangeli  P  et al.  Core isolation of critical arrhythmia elements for treatment of multiple scar-based ventricular tachycardias. Circ Arrhythm Electrophysiol  2015;8:353–61. PubMed

Krisai  P, Knecht  S, Badertscher  P, Mühl  A, Osswald  S, Roten  L  et al.  Troponin release after pulmonary vein isolation using pulsed field ablation compared to radiofrequency and cryoballoon ablation. Heart Rhythm  2022;19:1471–2. PubMed

Popa  MA, Bahlke  F, Kottmaier  M, Foerschner  L, Bourier  F, Lengauer  S  et al.  Myocardial injury and inflammation following pulsed-field ablation and very high-power short-duration ablation for atrial fibrillation. J Cardiovasc Electrophysiol  2024;35:317–27. PubMed