Pulsed field ablation of atrial arrhythmias in patients with cardiac implantable electronic devices: a multicenter evaluation of electrical integrity and device safety.

PURPOSE: Pulsed field ablation (PFA) uses high-intensity electric fields to create myocardial lesions and may potentially interact with cardiac implantable electronic devices (CIEDs). This multicenter study evaluated the effects of different PFA technologies on electrical integrity and device-related complications in patients undergoing left- and right-sided atrial ablation.

METHODS

Consecutive patients with CIEDs undergoing catheter ablation with 4 PFA technologies were included. CIED interrogation was performed at baseline, after ablation, and at ≥ 3-month follow-up. Study endpoints were electrical integrity, defined as changes in sensing, pacing threshold, or impedance, and clinically relevant PFA-related CIED malfunction. Real-time device monitoring was performed in a subgroup to assess electromagnetic interference (EMI).

RESULTS

A total of 157 patients were included. PFA was performed using a pentaspline catheter in 110 patients, a lattice-tip catheter in 26, a variable-loop circular catheter in 16, and a circular array catheter in 5. No significant changes in lead parameters were observed immediately after ablation or at 3-month follow-up, including in patients undergoing right atrial PFA. PFA was frequently associated with EMI-related oversensing (93%). Two patients (1.3%) experienced clinically relevant PFA-related CIED malfunction, consisting of transient reset of a leadless pacemaker and increase of atrial pacing threshold requiring lead revision, both occurring after right atrial lattice-tip PFA.

CONCLUSIONS

PFA for left- and right-sided atrial arrhythmias was associated with preservation of CIED electrical integrity at acute and 3-month follow-up despite frequent EMI-related oversensing. Clinically relevant PFA-related CIED malfunctions were uncommon; however, caution is warranted when delivering PFA in close proximity to CIED components. In this multicenter study, PFA of left- and right-sided atrial arrhythmias using four contemporary technologies demonstrated preserved CIED electrical integrity at acute and 3-month follow-up despite frequent EMI-related oversensing. Clinically relevant PFA-related CIED malfunctions were uncommon (1.3%), although caution is warranted when delivering PFA in close proximity to CIED components.