Ventricular Pulsed Field Ablation: State-of-the-art Review of Preclinical and Clinical Evidence

Pulsed field ablation (PFA) is a paradigm shift in the field of cardiac electrophysiology. The well-demonstrated success with atrial PFA is generating enthusiasm for ventricular applications of PFA, for which the clinical experience is still in its infancy, however. This study is a systematic review and critical appraisal of the published preclinical and clinical evidence on ventricular PFA, involving a total of 111 primary articles (55 preclinical and 56 clinical). An increasing number of PFA platforms and catheters are being used in the ventricle in clinical practice. This appraisal evaluates the impact of ablation parameters in association with lesion depth and volume, and synthesises the available studies of safety and efficacy outcomes for ablation of ventricular tachycardia and premature ventricular complexes with PFA, as reported in case reports and case series from around the world. The cumulative published evidence amounts to a total of 434 patients ablated with PFA for ventricular arrhythmias, with generally favourable acute and long-term results, while the understanding of safety constraints continues to be explored.