AIMS: The feasibility and safety of the lattice-tip catheter for ventricular arrhythmia (VA) ablation in humans remain largely unknown. This study aimed to assess feasibility, safety profile as well as patient outcomes after VA ablation with a lattice-tip catheter in a multicentre European registry. METHODS AND RESULTS: All 18 European centres using the AFFERA system in September 2024 agreed to participate. Clinical, procedural, and follow-up data (minimum 3 months) were systematically collected and analysed. A total of 126 patients (18% female; mean age 59 ± 16 years) underwent VA ablation using the lattice-tip catheter during the inclusion period. Ablation indications included ventricular tachycardia (VT) in 99, premature ventricular complexes (PVCs) in 23, and ventricular fibrillation (VF) in 4 patients. Major and minor acute complications were observed in 7 (6%) and 18 (14%) procedures, respectively. They included thrombo-embolic event (n = 2), major bleeding (n = 2), ventricular fibrillation induction (n = 1), tamponade due to epicardial access (n = 1), and cardiogenic shock due to prolonged VT mapping (n = 1). Within the first month post-procedure, three patients died [from multi-organ failure (n = 2) and sepsis (n = 1)], two had worsening heart failure, one myocardial infarction, one sepsis, and one major gastro-intestinal bleeding. After a mean follow-up of 5.6 ± 3.7 months, absence of recurrence was 78% for PVC, 70% for VT, and 100% for VF. CONCLUSION: In this complex population with refractory VA, ablation using the lattice-tip catheter appears feasible and relatively safe. In the absence of large, randomized trials, exhaustive registry is of key importance to ensure safety and efficacy of new catheter technologies.

• Keywords
• Lattice-tip catheter, Pulsed field ablation, Safety, VT ablation,
• MeSH
• Equipment Design MeSH
• Ventricular Fibrillation * surgery   physiopathology   MeSH
• Catheter Ablation * instrumentation   adverse effects   MeSH
• Tachycardia, Ventricular * surgery   physiopathology   diagnosis   MeSH
• Ventricular Premature Complexes * surgery   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Recurrence MeSH
• Registries MeSH
• Aged MeSH
• Cardiac Catheters * adverse effects   MeSH
• Feasibility Studies 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
• Geographicals
• Europe MeSH

Epicardial access during electrophysiology procedures offers valuable insights and therapeutic options for managing ventricular arrhythmias (VAs). The current clinical consensus statement on epicardial VA ablation aims to provide clinicians with a comprehensive understanding of this complex clinical scenario. It offers structured advice and a systematic approach to patient management. Specific sections are devoted to anatomical considerations, criteria for epicardial access and mapping evaluation, methods of epicardial access, management of complications, training, and institutional requirements for epicardial VA ablation. This consensus is a joint effort of collaborating cardiac electrophysiology societies, including the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society.

• Keywords
• Cardiomyopathies, Catheter ablation, Clinical consensus statement, Electrophysiology procedures, Epicardial access, Ventricular arrhythmias, Ventricular fibrillation, Ventricular tachycardia,
• MeSH
• Electrophysiologic Techniques, Cardiac * standards   MeSH
• Epicardial Mapping * standards   MeSH
• Cardiology * standards   MeSH
• Catheter Ablation * standards   adverse effects   methods   MeSH
• Tachycardia, Ventricular * surgery   diagnosis   physiopathology   MeSH
• Consensus MeSH
• Humans MeSH
• Pericardium * surgery   physiopathology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH