January 2026

CARDIOVASCULAR

CASE REPORT: PULSED FIELD ABLATION FOR VENTRICULAR ARRHYTHMIAS

Featuring: Bradley P. Knight, MD
Clinical Scenario
A 54-year-old male with CAD and systemic sclerosis presented with frequent, symptomatic premature ventricular contractions (PVCs). Months prior he was treated unsuccessfully with radiofrequency (RF) ablation. PVCs at that time were mapped to the posterior papillary muscle and inferior left ventricular (LV) base. The treatment failed — likely due to catheter instability, inadequate mapping or deep intramural focus beyond RF lesion depth.

​Using a 9-millimeter lattice-tip dual-energy RF/PFA catheter, ultra-high-density mapping identified the PVC origin near the mitral annulus. In this patient, a combination of RF and PFA lesions successfully eliminated PVCs without recurrence overnight.
Current lattice-tip systems achieve only about 5- to 6-milimeter lesion depth. While ablation succeeded in this case, patients with deeper ventricular tachycardia (VT) circuits may benefit from a tool that can deliver deeper lesions.

​Diving In Deep: VCAS Evaluates PFA Tool
The Ventricular Catheter Ablation Study (VCAS) was published in October 2025 and evaluated catheter ablation for scar-related VT using a novel 8.5 French, force-sensing, high-voltage pulsed field ablation (PFA) catheter. VCAS found:
  • Transmural LV lesions achieved from endocardial approach, confirmed via epicardial mapping
  • 98% reduction in VT burden post-ablation
  • Few complications; none clearly energy-specific

VCAS Practice Implications
  • Limitations: RF energy struggles with intramural or papillary muscle arrhythmias. Alternatives being developed include needle-based irrigated RF catheters, external radiation therapy, ultra-low-temperature cryoablation, and coronary venous alcohol injection.
  • Advantage: PFA is non-thermal, tissue-selective and now capable of deeper lesion formation — potentially reducing need for epicardial procedures in refractory VT.

​PFA is emerging as a transformative tool for complex ventricular arrhythmias, especially those inaccessible to conventional RF. Careful lesion dosing will be critical as technology evolves.
Bradley P. Knight, MD, Chester C. and Deborah M. Cooley Distinguished Professor of Cardiology, Professor of Cardiology

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