DGK Herztage 2025. Clin Res Cardiol (2025). https://doi.org/10.1007/s00392-025-02737-x
1Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland
Background – Pulsed field ablation (PFA) has rapidly become the leading energy source for pulmonary vein isolation (PVI) in atrial fibrillation, offering superior tissue selectivity and safety compared to traditional methods. While the general safety profile of PFA is well-established, there is growing evidence that a high-dose approach, using additional applications beyond the standard protocol, is both safe and can further improve lesion durability. However, the impact of such a high-dose approach on the safety and functionality of cardiac implantable electronic devices (CIEDs) during PFA procedures has not yet been systematically investigated.
Methods – Patients with transvenous CIED, including pacemakers and implantable cardioverter-defibrillators (ICDs), who underwent PFA-PVI between August 2022 and March 2025 and provided written informed consent were included in this study. All procedures were performed using a high-dose PFA-PVI approach, delivering 12 applications per pulmonary vein using a penta-spline catheter. Device interrogation was performed immediately before the procedure (T0), immediately after the procedure (T1), and 24 hours post-procedure (T2).
Results – A total of 30 patients (mean age 72.9 ± 12 years; 40% female; 22 pacemakers, 8 ICDs) were included in this study. No peri- or postprocedural device-related complications occurred. Device interrogation showed stable lead thresholds, sensing amplitudes, and impedances across the right atrial (RA) and right ventricular (RV) leads. RA lead thresholds remained consistent before, immediately after, and 24 hours post-procedure. RA lead sensing increased post-procedure and remained elevated at 24 hours. RA lead impedance initially decreased post-procedure but increased again at 24 hours (Figure 1A). RV lead thresholds showed a minor decrease post-procedure with no significant changes in sensing. RV lead impedance decreased post-procedure with return to baselin at 24 hours 8F.
Conclusions – Our findings show that a high-dose PFA-PVI approach using a Penta-spline catheter does not compromise the safety or function of cardiac implantable electronic devices. These results support the procedural safety of high-dose PFA-PVI in patients with CIEDs. Further studies are needed to evaluate long-term effects.