PULSED FIELD ABLATION IN PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES - TECHNICAL ASPECTS OF INTERACTION: OBSERVATIONAL CASE STUDY
DOI:
https://doi.org/10.14311/CTJ.2025.1.02Abstract
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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Copyright (c) 2025 Jan Morava, Tomáš Roubíček, Aleš Richter
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