Pulsed field ablation as a bailout for ventricular tachycardia ablation: a case report.

Background: Catheter ablation of ventricular tachycardia (VT) using radiofrequency energy has proven to be an effective therapy. The outcome in patients presenting with an intramural septal substrate has however been disappointing. New tools and energy such as pulsed field ablation (PFA) might improve our efficacy to treat arrhythmia in this setting.

Case summary: A 64-year-old patient with valvular and ischaemic cardiomyopathy had recurrence of arrhythmic storm despite previous endocardial ablation and stereotactic body radiation therapy targeting the interventricular septum. A new attempt using PFA via a novel large footprint 9 mm lattice-tip catheter allowed to achieve non-inducibility. Early recurrence of VT however occurred, necessitating a second procedure targeting zones that were ablated in the previous procedure. Careful analyses of the first procedure highlighted three possible technical reasons for this recurrence, which were taken into account during the redo ablation. At 7-month follow-up, the patient remained free from VT.

Discussion: Endocardial ablation applying pulsed field energy through a lattice-tip catheter was capable of successfully treating an intramural septal substrate in a patient with multiple prior failed ablation procedures. Extra attention should be paid to specific properties of PFA for VT to avoid recurrences.