ArticleJACC. Case reports2026
Endo-Epicardial Ventricular Tachycardia Ablation With Pulsed-Field Energy in an Extravascular ICD Recipient.
Article in JACC. 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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8 authors.
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Abstract
backgroundExtravascular implantable cardioverter-defibrillator (EV-ICD) recipients may require epicardial ventricular tachycardia (VT) ablation, raising device and access considerations. FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: A 62-year-old man with ischemic cardiomyopathy (left ventricular ejection fraction: 38%) and electrical storm despite antiarrhythmics and prior endocardial ablation underwent hybrid endo-epicardial VT ablation guided by right ventricular apex S1-S2-S3 mapping. A basal-mid inferolateral epicardial deceleration zone with local abnormal ventricular activity and a diastolic pathway were targeted. Pulsed-field (PF) applications with limited adjunct radiofrequency (RF) abolished the epicardial deceleration zone and the clinical VT; a rapid nonclinical VT remained inducible. Concomitant substernal lead repositioning was performed for noise oversensing. No complications occurred; defibrillation testing was effective, and 30-day remote monitoring showed no arrhythmic events. DISCUSSION: A pragmatic workflow integrated computed tomography-guided epicardial planning, functional substrate mapping, PF ± RF delivery, and EV-ICD management. NOVELTY: This is to our knowledge the first reported combination of PF-based endo-epicardial VT ablation with concomitant substernal lead repositioning in an EV-ICD recipient. TAKE-HOME MESSAGE: Hybrid PF-based VT ablation can be integrated with EV-ICD management.
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