Feasibility of pulsed field ablation for ventricular arrhythmia: a systematic review

Introduction Beyond its efficacy on atrial fibrillation, pulsed field ablation (PFA) presents potential advantages in ventricular arrhythmia. This study sought to investigate the feasibility of PFA for ventricular tachycardia (VT) and premature ventricular complexes (PVC).Method A systematic search (Scopus, PubMed, and Science Direct) with citation searching was performed on 9 January 2026. Studies evaluating the feasibility of PFA in VT and PVC were included.Result This study included seven studies (74 patients with VT and 86 with PVC). Pooled acute procedural success rate in VT was 0.92 (95% CI: 0.86–0.99) and in the PVC was 0.93 (95% CI: 0.86–1.00). During follow-up, VT recurrence rates ranged from 20% to 54%. PVC ablation demonstrated a significant burden reduction (MD: 86.54%; 95% CI: 59.21–113.86; p = 0.005) with long-term success rates ranging from 50% to 85%. Safety evaluation demonstrated satisfactory outcomes, with major adverse cardiovascular events (MACE) during follow-up occurring in four patients with high-risk comorbidity. Major adverse events (AEs) occurred in 11 patients and were preventable; minor AEs consisted solely of vascular access site AEs.Conclusion PFA was feasible for VT and PVC ablation. Larger long-term studies and standardized protocol were urgently necessary to ensure efficacy with minimal AEs.Protocol registration www.crd.york.ac.uk/prospero identifier is CRD420251272352