Pulsed Field Ablation in Patients With Cardiac Implantable Electric Devices: Vigilance Is Warranted

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Pulsed field ablation (PFA) offers potential safety advantages over thermal ablation for atrial fibrillation treatment.
• High-voltage PFA pulses may pose risks to patients with cardiac implantable electronic devices (CIEDs).
• Existing clinical trials often exclude patients with CIEDs, creating an evidence gap.

Purpose of the Study:

• To review potential hazards of PFA in patients with CIEDs.
• To present current real-world evidence on PFA use in patients with CIEDs.
• To recommend workflows for mitigating risks and ensuring patient safety during PFA procedures in this population.

Main Methods:

• Literature review of PFA and CIED interactions.
• Analysis of real-world clinical data for PFA in CIED patients.
• Development of risk mitigation strategies and safety protocols.

Main Results:

• PFA's strong electric fields can cause electromagnetic interference (EMI) or damage to CIEDs.
• Limited real-world data exists, highlighting the need for further investigation.
• Specific protocols can help manage risks associated with PFA in CIED patients.

Conclusions:

• Performing PFA in patients with CIEDs requires careful consideration of potential risks.
• Real-world evidence is crucial for understanding and managing PFA-CIED interactions.
• Implementing standardized safety workflows is essential for the safe application of PFA in patients with CIEDs.