Key result
Catheter ablation triggers unexpected asynchronous CIED pacing and ventricular fibrillation despite disabled noise reversion mode.
Why the study?
The potential for asynchronous pacing and ventricular fibrillation induced by CIED noise reversion mode during radiofrequency catheter ablation is not well characterized.
Case Report (n=1)
Unexpected CIED asynchronous pacing can induce VF during ablation despite disabled noise reversion; leaves open whether current safeguards reliably prevent electromagnetic interference effects.
Prior to ventricular tachycardia ablation, this patient's cardiac implantable electronic device (CIED) was temporarily programmed to backup pacing mode with tachycardia therapies disabled. During radiofrequency energy delivery, the patient developed ventricular fibrillation requiring emergent cardioversion. Electrogram interrogation showed that the CIED switched to noise reversion mode during ablation. The consequent asynchronous pacing resulted in a paced QRS landing on an intrinsic T wave, inducing ventricular fibrillation. This serves as an important reminder that asynchronous pacing consequent to CIED oversensing could occur in any procedure that could cause electromagnetic interference such as radiofrequency cathteter ablation.
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Nam et al. (2021) conducted a case report in Ischemic cardiomyopathy with ventricular tachycardia and cardiac implantable electronic device (n=1). Radiofrequency catheter ablation was evaluated on Ventricular fibrillation induced by asynchronous pacing. During radiofrequency catheter ablation, the patient's cardiac implantable electronic device switched to asynchronous pacing despite disabled noise reversion mode, inducing ventricular fibrillation.
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