Pulsed Field Ablation for Atrial Fibrillation in Patients with Cardiac Implantable Electronic Devices
Date
2025
Authors
Abbas, M.
Emami, M.
Kamsani, S.H.
Ariyaratnam, J.P.
Wilson, L.
Stolcman, S.
Schirripa, V.
Pattu Valappil, S.
Fitzgerald, J.
Evans, S.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Heart Rhythm, 2025; 22(9):e594-e604
Statement of Responsibility
Mohamed Abbas, Mehrdad Emami, Suraya Hani Kamsani, Jonathan P. Ariyaratnam, Lauren Wilson, Simon Stolcman, Vince Schirripa, Sanjai Pattu Valappil, John Fitzgerald, Shaun Evans, Alessandra Pina, Monika Gawałko, Mohanaraj Jayakumar, Christopher X. Wong, Glenn D. Young, Prashanthan Sanders
Conference Name
Abstract
Background Multiple studies have demonstrated the safety of pulsed-field ablation (PFA) systems; however, patients with cardiac implantable electronic devices (CIEDs) have been excluded because of concerns about the impact of strong electrical fields on device function and integrity. Objective This study assesses the effect of PFA on the function and integrity of CIEDs. Methods Patients with atrial fibrillation undergoing ablation were studied at 2 sites. PFA was performed to achieve pulmonary vein and posterior wall isolation. CIEDs were interrogated before and after PFA to assess function (threshold, sensing), integrity (impedance), and arrhythmia episodes. Real-time interrogation of the CIEDs was also performed to evaluate the effect of PFA electrical noise on the CIEDs. Results In the last 24 months, we performed 329 PFA procedures, using 4 different PFA systems; 35 of them in patients with CIEDs. The mean age was 70.0 ± 8.8 years, 40.0% female. Results of post-procedural testing revealed no significant changes in lead impedance, pacing threshold, or sensing of intrinsic activities. Results of real-time interrogation of the CIEDs revealed that PFA electrical noise was often found when the PFA catheter is in proximity (eg, right pulmonary veins and posterior wall). Moreover, PFA electrical noise resulted in ventricular pacing inhibition for 2.5 and 3.7 seconds in 2 patients and atrial pacing inhibition for 2.1 seconds in 1 patient. Conclusion The function and integrity of CIEDs were not compromised by PFA in this study patient cohort; however, transient ventricular pacing inhibition was observed.
School/Discipline
Dissertation Note
Provenance
Description
Access Status
Rights
© 2025 Heart Rhythm Society. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.