Innovative ablation technique for cancer patients: assessing pulsed field ablation in atrial fibrillation

Background/Introduction The precise mechanisms underlying the induction of atrial fibrillation (AF) in cancer patients are not yet fully elucidated. The development of AF in this patient population is thought to result from a multifactorial interplay of mechanisms, including chronic inflammation, oxidative stress, autonomic nervous system dysregulation, cardiac structural changes induced by cancer therapies, electrolyte imbalances, and a prothrombotic state associated with malignancy. Furthermore, chemotherapeutic agents such as cisplatin have been associated with an AF incidence ranging from 15% to 32%, while anthracyclines are linked to AF in approximately 10% of cases. Cancer itself often induces a state of heightened inflammatory stress, and various cancer treatments, including radiation, chemotherapy, and immunotherapy, are known to be cardiotoxic, significantly increasing the risk of AF onset. Purpose Recent meta-analyses have investigated the efficacy and safety of radiofrequency ablation as a treatment for atrial fibrillation in oncological patients. However, there is a lack of data regarding the efficacy and safety of pulsed field ablation in this particular group. The objective of this study is to evaluate the efficacy and safety of pulsed field ablation in cancer patients with AF. Methods/Results: A retrospective cohort study will be conducted to include patients with active cancer who underwent pulsed field ablation for the treatment of atrial fibrillation. The rates of procedure-related complications and recurrence of AF will be assessed. All procedures were performed between January 1, 2022, and December 31, 2024, and a total of 147 participants were enrolled in this study. Two primary outcomes were evaluated: procedure-related complications and the first occurrence of AF recurrence within 12 months. Data were collected from catheter ablation reports, and the complications were categorized according to two dichotomous variables: the existence of acute complications directly during the procedure or within the first 24 hours after the end of the procedure, and the occurrence of self-limited arrhythmic events during the blanking period. The proportion of patients free of sustained episodes of AF at 12 months (primary endpoint) was 62% with 2% of complications with no differences in recurrence despite the type of cancer. Conclusion Pulsed field ablation represents an effective and safe therapeutic modality for cancer patients. Compared to radiofrequency ablation, pulsed field energy is associated with a lower complication rate and offers the advantage of a faster procedure, facilitating quicker recovery for patients. This registry is the first to demonstrate that pulsed field ablation exhibits a safety and efficacy profile in oncological patients comparable to that observed in the general patient population.