Dual-Energy Pulsed Field and Radiofrequency Ablation With a Contact Force–Sensing Focal Catheter for Ventricular Arrhythmias: Initial Clinical Experience
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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.
Clinical Perspective
What is Known
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Radiofrequency ablation may be limited by ventricular wall thickness and complex scar, and focal pulsed field and dual-energy approaches have been explored in early clinical studies.
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Clinical evidence is specific to the catheter platform and energy-delivery protocol, and the incremental benefit of sequential RF and PF delivery remains uncertain.
What the Study Adds
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A sequential RF-first and PF-consolidation workflow with the contact force–sensing DE-STSF catheter was feasible in 26 consecutive patients undergoing VT or PVC ablation, including selected epicardial applications.
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Acute noninducibility was achieved in 16 of 18 VT patients and acute PVC elimination in all 8 PVC patients; no major in-hospital procedure-related complications were documented, although one transient LV lead parameter change occurred.
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These encouraging initial results support further prospective evaluation of the DE-STSF catheter for ventricular arrhythmia ablation, with a focus on optimizing energy delivery and assessing long-term efficacy and safety.
