Brad Wilson: Hello everyone and welcome to this discussion on Arrhythmia Academy. I'm joined today by Dr. Pasquale Santangeli from Cleveland Clinic Ohio. We wanted to dive into his experience regarding the early US experience with the Medtronic dual-energy lattice tip catheter. Pasquale, could you give us an overview of this dual-energy lattice catheter?

Pasquale Santangeli: Yes, of course. It is a very interesting catheter platform capable of delivering both radiofrequency (RF) ablation and pulsed field ablation (PFA). It is a dual-energy platform with a large footprint 9 mm lattice sphere that is very easy to maneuver and manipulate in different parts of the ventricle. A second important benefit is that it provides a single solution for high-resolution mapping and ablation, meaning there are no catheter exchanges, which is very appealing for VT substrate.

Brad Wilson: What was the rationale for exploring this technology further?

Pasquale Santangeli: As a tertiary center for VT ablation, we see fairly sick patients who sometimes have no other significant options. We know that standard technology, with its small footprint and large volume irrigation RF, may not be as beneficial because it cannot cover the full substrate and carries a high risk of decompensation from the irrigation. We selected these patients for our early experience, enrolling 59 patients out of roughly 360 VT ablations performed between January and September 2025. This is the largest single-center series and includes both ischemic and non-ischemic patients, as well as endo-epicardial mapping and ablation.

Brad Wilson: How do the initial outcomes look?

Pasquale Santangeli:The outcomes were quite favorable in a very high-risk population where most patients had multi-segment scar. Despite these challenging cases, we reached 70% VT freedom at 6 months. Acute outcomes were also promising: we saw 100% PVC suppression, approximately 79% non-inducibility for VT patients, and 100% elimination of electrograms. While we are still learning how these endpoints perform long-term with pulsed field ablation, it currently seems correlated with long-term success.

Brad Wilson: What has the learning curve been like as you build this experience?

Pasquale Santangeli:We have learned a lot. At our institution, we perform a transseptal approach, which is crucial for this platform because the catheter has a unique tendency to get tangled against the mitral or aortic valves. We capture the catheter with the sheath to prevent this. For **epicardial mapping**, we occasionally saw fat entrapment in the sphere; if we need to return to the endocardium, we always switch to a new catheter to prevent embolization because it is difficult to flush. Overall, I was very pleasantly surprised by how it performed in this challenging group.

Brad Wilson: How does the workflow differ from traditional RF platforms?

Pasquale Santangeli: I redesigned a standardized workflow for our institution. We always start with RF ablation because we know that VT termination or electrical elimination is meaningful with RFA, and then we supplement that with PFA. We avoid PFA in the border zones of contractile myocardium to prevent stunning, and we use only PFA for the epicardium.

One word of caution: if you ablate close to implantable devices like a pacemaker or defibrillator, the **PFA energy may shunt to the device. We had one case of ICD failure requiring a generator change when the distance was about 7.5 mm. We now use at least a 1 cm safety margin and have not seen that issue again.

Brad Wilson: To wrap up, what are the next steps for this technology?

Pasquale Santangeli: I think the future of VT ablation is very bright. We finally have a platform that allows us to cover large substrates efficiently. Our data is in line with registries in Europe, and we are currently publishing our best workflow to help others use this technology effectively.

Brad Wilson:Thanks, Pasquale. I appreciate your time and for sharing your insights with our audience.

Pasquale Santangeli:Thank you. My pleasure.