Acute Pericarditis After Pulsed Field Ablation for Atrial Fibrillation

Pulsed field ablation (PFA) is a novel nonthermal ablation technique for atrial fibrillation, offering myocardial selectivity and a favorable safety profile. However, postprocedural pericarditis remains rarely reported. A 62-year-old man with paroxysmal atrial fibrillation underwent PFA with intracardiac echocardiography. Ablation was delivered at 2.0 kV, and postprocedural intracardiac echocardiography showed no pericardial effusion. Twelve hours later, the patient developed pleuritic chest pain. Electrocardiography showed PR-segment depression and diffuse ST-segment elevation. Transthoracic echocardiography revealed a 3-mm pericardial effusion, with elevated inflammatory biomarkers. Acute pericarditis was diagnosed, and the patient was treated with hydrocortisone, ibuprofen, and colchicine, resulting in symptom resolution within 4 weeks. Despite the nonthermal mechanism of PFA, acute pericarditis may occur as an early complication. Indirect myocardial inflammation and immune-mediated responses may contribute. Early recognition enables timely management. Acute pericarditis can occur after PFA. Prompt anti-inflammatory therapy is essential for optimal outcomes.