Effects of Dual-Energy Lattice-Tip Catheter Ablation of Ventricular Arrhythmias on Cardiac Implantable Electronic Device Performance

BACKGROUND The Sphere-9 lattice-tip catheter (Affera, Medtronic) enables delivery of both radiofrequency ablation (RFA) and pulsed field ablation (PFA) for ventricular arrhythmia (VA) ablation. Data on its impact on cardiac implantable electronic devices (CIEDs) are limited. OBJECTIVES This study sought to evaluate changes in CIED function following VA ablation using the Sphere-9 catheter. METHODS We reviewed 65 consecutive patients (median age 71 years, 94% male, 63% ischemic cardiomyopathy, median left ventricular ejection fraction 31%) with pre-existing CIEDs who underwent VA ablation (62 ventricular tachycardia [95%], 3 premature ventricular contraction [5%]) using the Sphere-9 catheter (combined RFA/PFA (53 [82%]), RFA alone (6 [9%]), PFA alone (6 [9%])). Device interrogation was performed within 30 days preprocedure, within 7 days postprocedure, and at 3-month (+/- 30 days) follow-up. RESULTS At 3-months, right ventricular leads demonstrated reduced sensing amplitude (11.7-10.0 mV, P = 0.04), pacing impedance (441-422 Ω, P < 0.001), shock impedance (64-59 Ω, P = 0.01), and increased capture threshold (0.9-1.0 V at 0.4-0.5 milliseconds, P = 0.03). Left ventricular (LV) leads demonstrated reduced pacing impedance (544-475 Ω, P = 0.04), whereas LV capture threshold remained elevated (1.0-1.4 V, P = 0.08). Right atrial lead parameters remained stable. No patient required CIED revision. One patient experienced cardiac resynchronization therapy-D pulse generator failure during PFA delivery 7.5 mm from an LV lead tip electrode, requiring generator replacement. CONCLUSIONS Ventricular arrhythmia ablation using the Sphere-9 dual-energy lattice-tip catheter was associated with small but persistent changes in right and left ventricular lead parameters. Serious CIED interactions were uncommon, and further studies are needed to better understand the underlying mechanisms.