Pulsed Field Ablation for Ventricular Arrhythmias: A Systematic Review and Single-Arm Meta-Analysis

Pulsed field ablation (PFA) is an emerging nonthermal ablation modality that can penetrate scar tissue more deeply. However, the evidence supporting its application in ventricular arrhythmias (VAs) is limited. This study summarizes relevant research and aims to evaluate the safety and efficacy of PFA in the treatment of premature ventricular contractions (PVCs) or ventricular tachycardia (VT).

A computer-based search of PubMed, Embase, and the Cochrane Library identified studies evaluating PFA for VAs from database inception to December 31, 2025. Primary outcomes included acute procedural success rate, short- to mid-term success rate, and perioperative complication rate. A meta-analysis of single-arm studies was performed using a random-effects model with StataMP18.

Six studies were included, comprising 149 patients (84 with PVCs, 65 with VT). The overall acute success rate was 88% (95% CI: 82%-93%), with PVCs at 88% (95% CI: 79%-95%) and VT at 90% (95% CI: 80%-97%). The short-to-mid-term success rate was 73% (95% CI: 65%-80%) overall, with 80% (95% CI: 70%-89%) for PVCs and 63% (95% CI: 46%-80%) for VT. The overall perioperative complication rate was 15% (95% CI: 6%-26%). PFA for VT ablation had longer procedure and fluoroscopy times, as well as a greater number of PFA applications, compared to PVCs, but with considerable heterogeneity.

PFA demonstrates a good acute success rate and an acceptable perioperative complication rate in the treatment of VAs. While it shows a higher short-to-mid-term success rate in PVCs patients, its efficacy in VT patients remains limited.