ArticleEuropean heart journal. Case reports2026
Colocalized radiofrequency and pulsed field ablation of incessant ventricular tachycardia with suspected intramural circuit in ischaemic cardiomyopathy using a 3.5 mm single-tip catheter under eCPR: a case report.
Article in European heart journal. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Incessant ventricular tachycardia (VT) in advanced ischaemic cardiomyopathy is a life-threatening condition, particularly when maintained by deep intramyocardial scar channels that can be difficult to eliminate with conventional radiofrequency (RF) ablation. Pulsed-field ablation (PFA) is a non-thermal, myocardium-selective modality with the potential to target arrhythmogenic tissue while minimizing collateral injury. Case summary: We report a case of incessant VT in a 60-year-old man with severe ischaemic cardiomyopathy in whom acute VT termination and final non-inducibility were achieved using a sequential dual-energy strategy combining RF and PFA delivered with a 3.5 mm open-irrigated catheter capable of both modalities [Dual Energy THERMOCOOL SMARTTOUCH™ (DE-STSF), Johnson & Johnson MedTech]. The procedure was performed under extracorporeal cardiopulmonary resuscitation (eCPR) via veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during electrical storm. Despite VT termination and arrhythmia control, the patient died on Day 5 from refractory shock with progressive multiorgan failure. Discussion: This case supports the feasibility of colocalized sequential RF-PFA ('energy stacking') as an adjunct strategy for suspected intramural post-infarction VT substrate in selected high-risk patients. Supported by VA-ECMO, this dual-energy strategy achieved acute VT non-inducibility and arrhythmia control, despite an unfavourable overall clinical outcome. Further systematic evaluation is warranted to define the incremental role of dual-energy lesion delivery in ventricular substrates.
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