Dual-Energy Pulsed Field and Radiofrequency Ablation With a Contact Force-Sensing Focal Catheter for Ventricular Arrhythmias: Initial Clinical Experience

Background. Clinical data on ventricular ablation with a contact force-sensing focal catheter capable of delivering both radiofrequency (RF) and pulsed field (PF) energy are limited. Objective. To describe the procedural characteristics, acute efficacy, and safety of dual-energy ablation with the Dual Energy THERMOCOOL SMARTTOUCH SF (DE-STSF) catheter in consecutive patients with ventricular arrhythmias. Methods. This observational single-center study included all consecutive patients who underwent catheter ablation of premature ventricular contractions (PVCs) or ventricular tachycardia (VT) with the DE-STSF catheter between June and October 2026. Results. Twenty-six patients were included (median age 65.5 [55.8-71.0] years; 77% male; median left ventricular ejection fraction 44.0% [30.0-53.8]). Eighteen underwent VT ablation, including 10 with electrical storm or incessant VT and 6 with prior VT ablation; 8 underwent PVC ablation. All patients received RF followed by PF consolidation. Noninducibility of any sustained VT or ventricular fibrillation was achieved in 16/18 VT patients (89%), and acute PVC elimination in all 8 PVC patients. No major procedure-related complications were documented during hospitalization. During a median follow-up of 68 [47-82] days, VT recurred in 2 patients; of whom one patient underwent repeat endocardial and epicardial ablation. No PVC recurrences were documented. Conclusion. In this initial clinical experience, sequential RF and PF ablation using a single contact force-sensing catheter proved feasible for the treatment of ventricular arrhythmias, achieving high acute success with a favorable early safety profile. Whether PF consolidation confers incremental benefit beyond RF ablation alone warrants prospective comparative evaluation.