A high-voltage pulsed field ablation (PFA) catheter efficiently and safely treated scar-related ventricular tachycardia (VT) in the first-in-human VCAS study, according to results presented in Circulation.

The trial enrolled 26 patients with ischemic or non-ischemic scar-related VT who underwent ablation using an 8.5-French force-sensing PFA catheter. Each lesion was created using five high-voltage (>10 kV) short-duration monophasic pulses synchronized to the QRS complex. Acute procedural success was achieved in 24 patients (92%), with a median of 21 lesions per patient and a median ablation time of 31 minutes. Clinical VT was inducible in 88% of patients before ablation and in 6% afterward (P < 0.001).

Epicardial-endocardial voltage mapping confirmed transmural lesion formation in all patients treated with endocardial-only PFA. During six-month follow-up, 81.8% of patients remained free from recurrent VT, ventricular fibrillation, or implantable cardioverter-defibrillator shocks. Safety events occurred in 11.5% of patients, including cardiogenic shock, heart failure hospitalization, and retroperitoneal bleed.

These findings suggest that high-voltage PFA can reliably deliver transmural lesions in scar-related VT, offering a promising and efficient alternative to conventional ablation strategies for this challenging arrhythmia.