Does pulsed-field ablation near an intracardiac defibrillation catheter cause irreversible circuit damage in patients with paroxysmal atrial fibrillation?
Pulsed-field ablation delivered in extreme proximity to an intracardiac defibrillation catheter can cause irreversible internal circuit damage, highlighting the need for careful catheter positioning and potential disconnection of unused electrodes.
Pulsed-field ablation (PFA) is a non-thermal modality that induces cardiomyocyte death via irreversible electroporation, achieving effective pulmonary vein isolation (PVI) while sparing surrounding tissues.1-2 Although PFA is generally considered safe in patients with cardiac implantable electronic devices (CIEDs),3-5 its strong electric fields may interfere with device function, potentially causing circuit damage or inappropriate responses.6 Recently, irreversible internal damage to an implantable cardioverter-defibrillator (ICD) was reported when PFA was delivered directly to the superior vena cava (SVC) coil of the ICD lead.
Takahashi et al. (Thu,) studied this question.