This study evaluates the efficacy and safety of focal pulsed-field (PF) ablation for ventricular arrhythmias (VA) in two centers. The study included 44 patients, 57% of whom had previously failed radiofrequency (RF) ablation for VA. PF ablation was performed using a 4 mm solid-tip catheter, and the CENTAURI generator was used to deliver biphasic, monopolar pulsed fields synchronized to the R-wave. The primary outcomes were acute suppression of VA and non-inducibility of VT. Key findings include: - PF ablation was feasible and effective, with high acute success rates in both ventricular premature complexes (VPC) and scar-related ventricular tachycardias (VT). - Despite favorable acute results, recurrences were common in the VT group, suggesting that acute non-inducibility may not be the optimal endpoint. - PF ablation within the great cardiac vein was not limited by high impedance or poor catheter cooling and was not associated with coronary artery spasm. - Unexpected conduction system block occurred in three cases during retrograde catheter ablation in the left ventricle due to current leakage from the proximal, shaft-visualizing electrodes. - Myocardial damage was assessed by troponin levels post-ablation, showing only moderate damage, which is reassuring given the nature of VA arrhythmias. The study highlights the potential benefits of PF ablation, including reduced risk of tissue overheating and better penetration into scar tissue. However, further research is needed to optimize the pulse configuration and assess the long-term outcomes and safety of PF ablation in various patient populations.This study evaluates the efficacy and safety of focal pulsed-field (PF) ablation for ventricular arrhythmias (VA) in two centers. The study included 44 patients, 57% of whom had previously failed radiofrequency (RF) ablation for VA. PF ablation was performed using a 4 mm solid-tip catheter, and the CENTAURI generator was used to deliver biphasic, monopolar pulsed fields synchronized to the R-wave. The primary outcomes were acute suppression of VA and non-inducibility of VT. Key findings include: - PF ablation was feasible and effective, with high acute success rates in both ventricular premature complexes (VPC) and scar-related ventricular tachycardias (VT). - Despite favorable acute results, recurrences were common in the VT group, suggesting that acute non-inducibility may not be the optimal endpoint. - PF ablation within the great cardiac vein was not limited by high impedance or poor catheter cooling and was not associated with coronary artery spasm. - Unexpected conduction system block occurred in three cases during retrograde catheter ablation in the left ventricle due to current leakage from the proximal, shaft-visualizing electrodes. - Myocardial damage was assessed by troponin levels post-ablation, showing only moderate damage, which is reassuring given the nature of VA arrhythmias. The study highlights the potential benefits of PF ablation, including reduced risk of tissue overheating and better penetration into scar tissue. However, further research is needed to optimize the pulse configuration and assess the long-term outcomes and safety of PF ablation in various patient populations.