Catheter ablation of ventricular arrhythmias (VAs) with a lattice-tip catheter that allows toggling between radiofrequency ablation and pulsed field ablation (PFA) "appeared effective and generally safe," based on findings from the CLEAR-VT Registry late-breaking clinical trial presented at HRS 2026 and simultaneously published in JACC: Clinical Electrophysiology. This study was the first in the U.S.

The study conducted by Osama Dasa, MD, PhD, et al., included nearly 60 patients (median age 70 years; mean LVEF 36.3%) who underwent ablation of VA using the lattice-tip catheter. Of these, 50 (85%) had scar-related ventricular tachycardia (VT) and 9 (15%) had frequent premature ventricular contractions (PVCs). Acute procedural success, defined as non-inducibility of any VT or complete PVC suppression, was achieved in 78% and 100% of patients, respectively.

In other findings, researchers noted that VT recurred in 9 patients (18%), and death/heart transplantation/left ventricular assist device implantation occurred in 6 patients (12%) after a median follow-up of 100 days. At 6 months, the Kaplan-Meier–estimated VT-free survival was 69.8%; the Fine-Gray cumulative incidence of VT recurrence, accounting for competing risks, was 28.4%. Additionally, no patient with PVCs had recurrence after a median follow-up of 54 days.

"Complications were uncommon but included acute device failure requiring intraoperative replacement and additional unique risks of catheter entrapment and fat entrapment within the sphere during epicardial mapping," researchers said. They added that caution should be used when applying PFA in proximity to exposed conductors of ICDs.

In a related editorial, Toshihiro Nakamura, MD, PhD, and Harikrishna Tandri, MD, note that "CLEAR-VT supports cautious optimism about feasibility while simultaneously narrowing the 'safe and sensible' use-case envelope." In addition to providing three key lessons learned, they highlight that "future prospective studies should:

1. Define objective selection criteria;
2. Prespecify mapping system reporting and substrate definitions to enable cross-center interpretability;
3. Incorporate predefined remapping and waiting protocols to characterize durability and reconnection; and
4. Explicitly study safety margins around coronary vasculature and CIED components.