August 31, 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
Alvise Del MonteAntonio BisignaniDomenico Giovanni Della RoccaVincenzo SchillaciCinzia MonacoMarco BergontiVedran VelagićSara PoggiWael ZaherAntonio SorgenteLorenzo MarconLuigi PannoneRoberto MenèGiampaolo VettaIvan EltsovGezim BalaErwin StrökerJuan SieiraAlexandre AlmoradAndrea SarkozyIngrid OvereinderGiuseppe StabileGiulio ConteStefano BianchiSerge BovedaPierre JaïsCarlo de AsmundisGian-Battista Chierchia
Key result
PFA preserves electrical integrity in CIED patients, with a 1.3% clinically relevant malfunction rate.
- n=157
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?
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.
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Implication
PFA in CIED patients warrants periprocedural monitoring for EMI and rare malfunctions; leaves open need for larger prospective safety data.
Abstract
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. Capsule summary 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.
J Interv Card Electrophysiol · cohort. Device patients undergoing PFA: EMI oversensing in 93% of monitored cases. Pulsed field ablation of atrial arrhythmias in patients with cardiac implantable electronic devices: a multicenter evaluation of electrical integrity and device safety 157 CIED patients: Pulsed field ablation for atrial arrhythmias. Lead parameters unchanged acutely and at 3 months: Sensing, Pacing threshold, Impedance. 1.3% of patients: Clinically relevant CIED malfunction in 2 patients. Both after right atrial lattice-tip PFA: Leadless pacemaker reset, Atrial threshold increase. Bottom line: PFA preserved device integrity; monitor for EMI and rare malfunctions.
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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%.