First United States Experience With Focal Pulsed-Field Ablation Using the FARAPOINT Catheter for Refractory Ventricular Tachycardia.

Abstract

Background: Drug-refractory ventricular tachycardia (VT) after failed radiofrequency (RF) ablation remains a clinical challenge. Pulsed-field ablation (PFA) is expanding to ventricular applications, but United States experience with focal pulsed-field-only catheters in VT is sparse, and pulsed-field platforms are not equivalent across manufacturers. Here we describe the first United States experience of FARAPOINT focal PFA in patients with refractory VT.

Methods and results: We retrospectively reviewed ten consecutive patients who underwent VT ablation with the FARAPOINT (Boston Scientific) focal PFA catheter at a single VA Health Care System between July 2025 and May 2026. All patients had drug-refractory sustained monomorphic VT. Median age was 77 years with a mix of ischemic and nonischemic cardiomyopathy. Six of ten had at least one prior failed catheter ablation. Acute non-inducibility was achieved in all nine patients who underwent formal post-ablation stimulation testing. No procedural complications occurred. Over a median follow-up of 95.5 days, sustained VT recurred in four of ten patients. No patient underwent repeat ablation, required mechanical circulatory support, or died.

Conclusions: In this initial United States experience, FARAPOINT was safe and acutely effective in patients with ischemic cardiomyopathy within a high-risk cohort with refractory VT and prior failed ablations, including challenging substrates. Prospective multicenter studies are warranted to expand these observations.