First-in-human use of the dual-energy SMARTTOUCH™ SF radiofrequency and pulsed field ablation catheter for ventricular arrhythmia treatment

procedure at another institution, the PVC was targeted with RF ablation at the posterior septal right ventricular outflow tract (RVOT) and at the anterior septal left ventricular outflow tract (LVOT) unsuccessfully.Coronary venous mapping was not performed due to inability to advance catheters distally into the coronary venous system. Investigational dual-energy RF and PF ablation systemThe patient consented to repeat catheter ablation with the THERMOCOOL SMARTTOUCH SF Dual Energy Catheter incorporating Pulsed Field Energy (Biosense Webster, Inc part of Johnson & Johnson MedTech, Irvine, CA) under compassionate use approval by FDA and the Mayo Clinic Institutional Review Board.This is a novel, investigational, dual-energy, contact force-sensing catheter that delivers irrigated RF as well as high-voltage, biphasic, monopolar, microsecond PF using a proprietary configuration via the TRUPULSE Generator (Biosense Webster, Inc).Each PF delivery consists of a train of 24 PF pulses without R-wave gating. Pre-procedure testingPre-procedure 24 h Holter monitoring demonstrated PVC burden 43% with a dominant PVC morphology of left bundle branch block, inferior axis and precordial transition at V3 (Fig. 1).Cardiac magnetic resonance imaging (CMR) demonstrated mid-myocardial late gadolinium enhancement (LGE) at the basal anterior and inferior septum, and the inferolateral left ventricle (LV).Left ventricular ejection fraction (LVEF) was quantified at 41%.