Key result
Pulsed field ablation safely isolated pulmonary veins without causing damage to cardiac implantable electronic devices or clinically significant pacing dysfunction, despite detectable electromagnetic interference.
Why the study?
The interaction between pulsed field ablation and cardiac implantable electronic devices during treatment of cardiac arrhythmias was not well characterized.
Does pulsed field ablation cause significant electromagnetic interference or device damage in patients with cardiac implantable electronic devices?
Case Report (n=2)
No
Does pulsed field ablation cause significant electromagnetic interference or device damage in patients with cardiac implantable electronic devices?
Pulsed field ablation appears technically safe and does not damage cardiac implantable electronic devices or cause clinically significant pacing disruptions during pulmonary vein isolation.
Hypothesis-generating for pulsed field ablation with cardiac implantable electronic devices; prospective studies needed before clinical adoption.
Pulsed field ablation (PFA) is a new method for treating cardiac arrhythmias. This method uses a sequence of high-voltage pulses to selectively destroy myocardial cells. The procedure can also be performed in patients with a cardiac implantable electronic device (CIED) such as a pacemaker (PCM) or an implantable cardioverter-defibrillator (ICD). The aim was to analyze such interaction of the pulse field and the pacing system. The interaction was assessed in two patients undergoing pulsed-field pulmonary vein isolation for paroxysmal atrial fibrillation in Liberec Regional Hospital. The first patient had a biventricular ICD, the CRT (cardiac resynchronization therapy) type. The second patient had a PCM, the 2D (dual-chamber) type. The signal waveform analysis was performed visually by an expert in real-time via the programmer (using real-time intracardiac electrogram) during each application of pulsed energy in the left atrium. The distance of the ablation catheter from the CIED sensing poles was <10 cm depending on the application in the left or the right pulmonary veins. On the intracardiac ECG, the interference from the PFA was detected by the device as an isolated cardiac event. In ICDs, the interference detection algorithm was also sporadically activated. There was no damage to the CIED electronics during PFA. CIED electronics is protected against high-energy pulsed fields used in these kind of interventions. Impulse interference is not a significant risk for affecting the stimulatory function of the CIED. All CIEDs have limits in signal processing as they are targeting the heart signal frequency range. The signal envelope from these high-frequency applications can be seen on the intracardiac ECGs. The signal processing parameters of CIEDs and the effect on pacing function may vary across different systems.
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Morava et al. (2025) conducted a case report in Atrial fibrillation with a cardiac implantable electronic device (CIED) (n=2). Pulsed field ablation (PFA) was evaluated on Electromagnetic interference and physical damage to CIEDs. Pulsed field ablation safely isolated pulmonary veins without causing damage to cardiac implantable electronic devices or clinically significant pacing dysfunction, despite detectable electromagnetic interference.
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