Temporary Loss of Pacemaker Capture During Focal Pulsed Field Ablation: A Case of Reversible Lead-Energy Interactions.

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.