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September 1, 2026Journal of Interventional Cardiac Electrophysiology

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

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Why the study?

Pulsed field ablation uses high-intensity electric fields that may potentially interact with cardiac implantable electronic devices.

Does pulsed field ablation preserve electrical integrity and avoid device malfunction in patients with cardiac implantable electronic devices?

Population

157 consecutive patients with CIEDs undergoing atrial catheter ablation

Comparison

Catheter ablation using 4 different PFA technologies

Design

Multicenter study

Follow-up

≥ 3-month

Key result

Pulsed field ablation for atrial arrhythmias in patients with cardiac implantable electronic devices preserved electrical integrity, with clinically relevant CIED malfunctions occurring in 1.3%.

Authors

AMAlvise Del MonteABAntonio BisignaniDRDomenico Giovanni Della Rocca

Discussion

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Overview

PFA in CIED patients warrants periprocedural monitoring for EMI and rare malfunctions; leaves open need for larger prospective safety data.

Key Points

  • To evaluate the electrical integrity and clinical safety of four different pulsed field ablation (PFA) technologies in patients with cardiac implantable electronic devices (CIEDs) undergoing atrial ablation.
  • Conducted a multicenter study of consecutive patients (N=157) with CIEDs undergoing left- and right-sided atrial PFA across 4 catheter platforms (pentaspline, lattice-tip, variable-loop circular, circular array).
  • Evaluated electrical integrity (sensing, pacing threshold, impedance) and electromagnetic interference (EMI) via device interrogation at baseline, immediately post-ablation, and at ≥3-month follow-up.
  • No significant changes in CIED lead parameters occurred acutely or at 3-month follow-up across both left- and right-sided ablation procedures.
  • Electromagnetic interference (EMI)-related oversensing was observed in 93% of monitored cases during pulse delivery.
  • Clinically relevant CIED malfunction occurred in 2 of 157 patients (1.3%), including a transient leadless pacemaker reset and an atrial threshold increase requiring lead revision, both after right atrial lattice-tip PFA.

Study Design

Type

Cohort (n=157)

Multicenter

Yes

Structured PICO

Does pulsed field ablation preserve electrical integrity and avoid device malfunction in patients with cardiac implantable electronic devices?

P
Population
157 patients with cardiac implantable electronic devices undergoing catheter ablation for atrial arrhythmias using pulsed field ablation, followed for at least 3 months.
E
Exposure
Pulsed field ablation (PFA) using pentaspline (n=110), lattice-tip (n=26), variable-loop circular (n=16), or circular array (n=5) catheters
O
Outcome
Electrical integrity (defined as changes in sensing, pacing threshold, or impedance) and clinically relevant PFA-related CIED malfunction at acute and ≥ 3-month follow-upsafety

Pulsed field ablation in patients with CIEDs appears safe with preserved electrical integrity at 3 months, though electromagnetic interference oversensing is common and caution is needed when ablating near device components.

Cite This Study

Monte et al. (2026) conducted a cohort in Atrial arrhythmias in patients with cardiac implantable electronic devices (n=157). Pulsed field ablation (PFA) was evaluated on Electrical integrity (changes in sensing, pacing threshold, or impedance) and clinically relevant PFA-related CIED malfunction. Pulsed field ablation for atrial arrhythmias in patients with cardiac implantable electronic devices preserved electrical integrity, with clinically relevant CIED malfunctions occurring in 1.3%.

synapsesocial.com/papers/6a969c53535111e2d4ce8d22https://doi.org/10.1007/s10840-026-02426-3
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