# Pulsed Field Ablation for the Treatment of Ventricular Arrhythmias Using a Focal, Contact-Force Sensing Catheter: A Single-Center Case Series and Review

## TL;DR

This study explores the use of pulsed field ablation (PFA) for treating ventricular arrhythmias with a contact-force sensing catheter, showing promising safety and effectiveness in a small group of patients.

## Contribution

The study presents a novel application of focal PFA using a contact-force sensing catheter for ventricular arrhythmias, demonstrating initial feasibility and safety.

## Key findings

- PFA achieved acute procedural success in all four patients without complications.
- PFA significantly reduced arrhythmic burden in PVC cases and rendered VT non-inducible in ischemic cardiomyopathy patients.
- No major adverse events such as coronary spasm or pericardial effusion were observed.

## Abstract

Background: Catheter ablation is a validated treatment for ventricular arrhythmias (VA), but conventional radiofrequency (RF) energy may cause collateral injury due to non-selective thermal damage. Pulsed Field Ablation (PFA), a non-thermal modality based on irreversible electroporation, offers myocardial tissue selectivity and enhanced safety. While PFA is widely adopted for atrial arrhythmias’ ablation, its application in the ventricles remains an evolving frontier. Methods: We report a single-center experience using the Centauri PFA system integrated with a focal, contact-force sensing irrigated catheter (Tacticath™ SE, Abbott Laboratories, St. Paul, MN, USA) in four consecutive patients with drug-refractory VA. Two patients presented with frequent premature ventricular complexes (PVC) arising from the right and left ventricular outflow tract, respectively, while two had ischemic cardiomyopathy with recurrent scar-related ventricular tachycardia (VT). All procedures were guided by high-density mapping using the EnSite X system (Abbott Laboratories, St. Paul, MN, USA). Procedural safety, acute efficacy, and early follow-up outcomes were assessed. Results: All ablations achieved acute procedural success without complications. In both PVC cases, PFA led to immediate and complete suppression of ectopy, with a ≥95% reduction in arrhythmic burden at 12- and 9-months follow-up, respectively. In the VT cases, the arrhythmogenic substrate was effectively modified, rendering the clinical VT non-inducible. ICD interrogation during a 9-month follow-up showed complete absence of recurrent sustained VT. No coronary spasm, atrioventricular block, pericardial effusion, or other adverse events occurred. Conclusions: In this initial experience, focal PFA using a contact-force sensing catheter appeared feasible and effective for both focal and scar-related VA. This system provides an intuitive workflow similar to RF ablation. While our data suggest a favourable safety profile, larger studies are required to definitively confirm safety margins near critical structures.