Pulsed Field Ablation for Atrial Fibrillation in Patients with Cardiac Implantable Electronic Devices

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dc.contributor.authorAbbas, M.
dc.contributor.authorEmami, M.
dc.contributor.authorKamsani, S.H.
dc.contributor.authorAriyaratnam, J.P.
dc.contributor.authorWilson, L.
dc.contributor.authorStolcman, S.
dc.contributor.authorSchirripa, V.
dc.contributor.authorPattu Valappil, S.
dc.contributor.authorFitzgerald, J.
dc.contributor.authorEvans, S.
dc.contributor.authorPina, A.
dc.contributor.authorGawałko, M.
dc.contributor.authorJayakumar, M.
dc.contributor.authorWong, C.X.
dc.contributor.authorYoung, G.D.
dc.contributor.authorSanders, P.
dc.date.issued2025
dc.description.abstractBackground 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.
dc.description.statementofresponsibilityMohamed 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
dc.identifier.citationHeart Rhythm, 2025; 22(9):e594-e604
dc.identifier.doi10.1016/j.hrthm.2025.04.045
dc.identifier.issn1547-5271
dc.identifier.issn1556-3871
dc.identifier.orcidEmami, M. [0000-0003-2093-6909]
dc.identifier.orcidAriyaratnam, J.P. [0000-0002-8801-8402]
dc.identifier.orcidFitzgerald, J. [0000-0003-3995-3549]
dc.identifier.orcidEvans, S. [0000-0001-5067-2743]
dc.identifier.orcidWong, C.X. [0000-0002-1913-6675]
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttps://hdl.handle.net/2440/147464
dc.language.isoen
dc.publisherElsevier
dc.relation.grantNHMRC
dc.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.
dc.source.urihttps://doi.org/10.1016/j.hrthm.2025.04.045
dc.subjectAtrial Fibrillation
dc.subjectCardiac implantable electronic devices
dc.subjectCatheter ablation
dc.subjectPulmonary vein isolation
dc.subjectPulsed-filed ablation
dc.titlePulsed Field Ablation for Atrial Fibrillation in Patients with Cardiac Implantable Electronic Devices
dc.typeJournal article
pubs.publication-statusPublished online

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