Lattice-tip dual energy ablation creates effective ventricular lesions through transmural scar that might inadvertently increase lead capture thresholds on the opposing surface

BACKGROUND: Achieving adequate lesion depth during ventricular tachycardia (VT) ablation within scar is challenging with conventional radiofrequency energy (RF). The lattice-tip catheter enables dual-energy ablation (RF & pulsed field [PF]) with enhanced tissue penetration. OBJECTIVE: We report on 3 cardiac implantable electronic device (CIED) patients with transmural apical left ventricular (LV) scars and drug-refractory VT. Each underwent endocardial LV ablation using RF & stacked PF. Ablation included delivery near the opposing surface of CIED leads, at sites critical for the VT circuit. CIED parameters were assessed pre- and post-procedure, as well as at interval follow-up. RESULTS: VT was eliminated with complete non-inducibility achieved in all cases, and there has been no recurrence at early follow-up (4-6months). However, each case demonstrated inadvertent CIED lead capture threshold rise (apical right ventricular x2, anterolateral LV coronary sinus branch x1), with partial recovery over time. Findings correlated with ablation near opposing lead electrodes. CONCLUSION: Dual-energy lattice-tip ablation creates effective ventricular lesions through transmural scar that may increase CIED capture thresholds on the opposing myocardial surface. Our report recommends vigilance during ablation opposing CIED leads, balancing the respective wall thickness and potential for lead damage against the gravity of the arrhythmic presentation.