Pulsed-field ablation for atrial fibrillation in patients with cardiac implantable electronic devices

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.

This study assesses the effect of PFA on the function and integrity of CIEDs.

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.

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.

The function and integrity of CIEDs were not compromised by PFA in this study patient cohort; however, transient ventricular pacing inhibition was observed.