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.

• Keywords
• Catheter ablation, Pulsed field, Radiofrequency ablation, Ventricular tachycardia,
• MeSH
• Action Potentials MeSH
• Time Factors MeSH
• Equipment Design MeSH
• Progression-Free Survival MeSH
• Adult MeSH
• Electrophysiologic Techniques, Cardiac * MeSH
• Catheter Ablation * methods   instrumentation   adverse effects   MeSH
• Tachycardia, Ventricular * surgery   physiopathology   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Recurrence MeSH
• Aged MeSH
• Cardiac Catheters * MeSH
• Feasibility Studies * MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

AIMS: A pulsed electric field (PF) energy source is a novel potential option for catheter ablation of ventricular arrhythmias (VAs) as it can create deeper lesions, particularly in scarred tissue. However, very limited data exist on its efficacy and safety. This prospective observational study reports the initial experience with VA ablation using focal PF. METHODS AND RESULTS: The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA. CONCLUSION: Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.

• Keywords
• Catheter ablation, Pulsed-field energy, Ventricular premature complexes, Ventricular tachycardia,
• MeSH
• Electrophysiologic Techniques, Cardiac MeSH
• Cicatrix etiology   MeSH
• Catheter Ablation * methods   adverse effects   MeSH
• Tachycardia, Ventricular * surgery   physiopathology   MeSH
• Ventricular Premature Complexes * surgery   physiopathology   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

AIMS: Patients with structural heart disease (SHD) undergoing catheter ablation (CA) for ventricular tachycardia (VT) are at considerable risk of periprocedural complications, including acute haemodynamic decompensation (AHD). The PAINESD score was proposed to predict the risk of AHD. The goal of this study was to validate the PAINESD score using the retrospective analysis of data from a large-volume heart centre. METHODS AND RESULTS: Patients who had their first radiofrequency CA for SHD-related VT between August 2006 and December 2020 were included in the study. Procedures were mainly performed under conscious sedation. Substrate mapping/ablation was performed primarily during spontaneous rhythm or right ventricular pacing. A purposely established institutional registry for complications of invasive procedures was used to collect all periprocedural complications that were subsequently adjudicated using the source medical records. Acute haemodynamic decompensation triggered by CA procedure was defined as intraprocedural or early post-procedural (<12 h) development of acute pulmonary oedema or refractory hypotension requiring urgent intervention. The study cohort consisted of 1124 patients (age, 63 ± 13 years; males, 87%; ischaemic cardiomyopathy, 67%; electrical storm, 25%; New York Heart Association Class, 2.0 ± 1.0; left ventricular ejection fraction, 34 ± 12%; diabetes mellitus, 31%; chronic obstructive pulmonary disease, 12%). Their PAINESD score was 11.4 ± 6.6 (median, 12; interquartile range, 6-17). Acute haemodynamic decompensation complicated the CA procedure in 13/1124 = 1.2% patients and was not predicted by PAINESD score with AHD rates of 0.3, 1.8, and 1.1% in subgroups by previously published PAINESD terciles (<9, 9-14, and >14). However, the PAINESD score strongly predicted mortality during the follow-up. CONCLUSION: Primarily substrate-based CA of SHD-related VT performed under conscious sedation is associated with a substantially lower rate of AHD than previously reported. The PAINESD score did not predict these events. The application of the PAINESD score to the selection of patients for pre-emptive mechanical circulatory support should be reconsidered.

• Keywords
• Acute haemodynamic decompensation, Catheter ablation, Mechanical circulatory support, PAINESD score, Risk assessment, Ventricular tachycardia,
• MeSH
• Hemodynamics * MeSH
• Hypotension etiology   physiopathology   diagnosis   MeSH
• Cicatrix physiopathology   MeSH
• Catheter Ablation * adverse effects   MeSH
• Tachycardia, Ventricular * surgery   physiopathology   etiology   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Pulmonary Edema etiology   diagnosis   physiopathology   MeSH
• Postoperative Complications etiology   diagnosis   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

• Keywords
• Catheter ablation, Clinical document, Electrical storm, Electroanatomical mapping, Electrocardiogram, Expert consensus statement, Imaging, Premature ventricular complex, Radiofrequency ablation, Ventricular arrhythmia, Ventricular tachycardia,
• MeSH
• Catheter Ablation * MeSH
• Tachycardia, Ventricular * surgery   MeSH
• Ventricular Premature Complexes * MeSH
• Consensus MeSH
• Humans MeSH
• Cardiac Electrophysiology MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

• Keywords
• Catheter ablation, Clinical document, Electrical storm, Electroanatomical mapping, Electrocardiogram, Expert consensus statement, Imaging, Premature ventricular complex, Radiofrequency ablation, Ventricular arrhythmia, Ventricular tachycardia,
• MeSH
• Cardiology * MeSH
• Catheter Ablation standards   MeSH
• Tachycardia, Ventricular surgery   MeSH
• Consensus * MeSH
• Humans MeSH
• Societies, Medical * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Research Support, N.I.H., Extramural MeSH

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

• Keywords
• Catheter ablation, Clinical document, Electrical storm, Electroanatomical mapping, Electrocardiogram, Expert consensus statement, Imaging, Premature ventricular complex, Radiofrequency ablation, Ventricular arrhythmia, Ventricular tachycardia,
• MeSH
• Electrophysiologic Techniques, Cardiac methods   MeSH
• Catheter Ablation * instrumentation   methods   standards   MeSH
• Tachycardia, Ventricular * diagnosis   etiology   physiopathology   surgery   MeSH
• Ventricular Premature Complexes * diagnosis   etiology   physiopathology   surgery   MeSH
• Consensus MeSH
• Humans MeSH
• International Cooperation MeSH
• Heart Diseases classification   complications   MeSH
• Heart Conduction System pathology   physiopathology   surgery   MeSH
• Societies, Medical MeSH
• Cardiac Electrophysiology * organization & administration   standards   trends   MeSH
• Treatment Outcome MeSH
• Quality Improvement organization & administration   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• Keywords
• Ablation, Anticoagulation, Arrhythmia, Atrial fibrillation, Atrial flutter, Atrial tachycardia, Catheter ablation, Stroke, Surgical ablation,
• MeSH
• Atrial Fibrillation diagnosis   physiopathology   surgery   MeSH
• Catheter Ablation adverse effects   standards   MeSH
• Consensus MeSH
• Cryosurgery adverse effects   standards   MeSH
• Humans MeSH
• Risk Factors MeSH
• Cardiac Catheterization adverse effects   standards   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Practice Guideline MeSH

• Keywords
• Ablation, Anticoagulation, Arrhythmia, Atrial fibrillation, Atrial flutter, Atrial tachycardia, Catheter ablation, Stroke, Surgical ablation,
• MeSH
• Atrial Fibrillation diagnosis   physiopathology   surgery   MeSH
• Catheter Ablation adverse effects   standards   MeSH
• Consensus MeSH
• Cryosurgery adverse effects   standards   MeSH
• Humans MeSH
• Risk Factors MeSH
• Cardiac Catheterization adverse effects   standards   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Practice Guideline MeSH

• Keywords
• AAD, antiarrhythmic drug, AF, atrial fibrillation, AFL, atrial flutter, Ablation, Anticoagulation, Arrhythmia, Atrial fibrillation, Atrial flutter, Atrial tachycardia, CB, cryoballoon, CFAE, complex fractionated atrial electrogram, Catheter ablation, LA, left atrial, LAA, left atrial appendage, LGE, late gadolinium-enhanced, LOE, level of evidence, MRI, magnetic resonance imaging, OAC, oral anticoagulation, RF, radiofrequency, Stroke, Surgical ablation,
• Publication type
• Journal Article MeSH

• Keywords
• Ablation, Anticoagulation, Arrhythmia, Atrial fibrillation, Atrial flutter, Atrial tachycardia, Catheter ablation, Stroke, Surgical ablation,
• MeSH
• Atrial Fibrillation diagnosis   physiopathology   surgery   MeSH
• Cardiac Surgical Procedures standards   MeSH
• Catheter Ablation standards   MeSH
• Consensus MeSH
• Humans MeSH
• Risk Factors MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH