Temporary Loss of Pacemaker Capture During Focal Pulsed Field Ablation: A Case of Reversible Lead-Energy Interactions
Daniel Joseph Gonzalez1, Rahul Devathu1, Kushal Chatterjee1
1Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Background:
Pulsed field ablation (PFA) is increasingly used for atrial arrhythmia ablation and is considered safe in patients with cardiac implantable electronic devices, though intraprocedural lead interactions remain undercharacterized.
Case:
We report a 75-year-old woman with a dual-chamber pacemaker who underwent focal PFA for recurrent atrial tachycardia using a 9-mm lattice-tip catheter. Immediately following PFA near the superior vena cava-right atrial junction, atrial lead capture was lost with transient right atrial lead threshold elevation and T-wave oversensing. All parameters normalized within 1 h.
Conclusions:
This case highlights reversible lead-energy interactions and the importance of real-time device monitoring when ablating near indwelling leads.
Related Concept Videos
Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Dysrhythmias IV: Characteristics of Bradyarrhythmias


