Pulsed field ablation-based pulmonary vein isolation in atrial fibrillation patients with cardiac implantable electronic devices: practical approach and device interrogation (PFA in CIEDs)

Chen, Shaojie; Chun, Julian K R; Bordignon, Stefano; Urbanek, Lukas; Schaack, David; Ebrahimi, Ramin; Schulte‐Hahn, Britta; Schmidt, Boris

doi:10.1007/s10840-022-01445-0

Cited by 14 publications

(6 citation statements)

References 21 publications

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“…A study on the use of electrochemotherapy/electroporation of the liver in patients with CIEDs also demonstrated EMI in the form of pacing inhibition during pulse application complimenting our data suggesting that EMI may be a clinical feature of PFA [11]. Two previous studies evaluated a total of 21 patients with CIEDs (15 pacemakers, 3 ICDs and 3 CRT-Ds in total) undergoing PFA for atrial fibrillation [12,13]. In these patients, there was no reported adverse outcomes or EMI; it is possible that the in vivo distance from the PFA catheter to the CIED components was greater than in our study explaining difference in results.…”

Section: Discussionsupporting

confidence: 85%

Pulsed field ablation in patients with cardiac implantable electronic devices: an ex vivo assessment of safety

Lennerz,

O’Connor,

Schaarschmidt

et al. 2024

J Interv Card Electrophysiol

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Background Pulse field ablation (PFA) is a novel catheter ablation technology with potential safety benefits due to its tissue selectivity. It has the potential to directly damage or interact with the functionality of cardiac implantable electronic devices (CIEDs) in the form of electromagnetic interference (EMI). The aim of our study was to assess the impact of PFA on CIEDs. Methods PFA lesions (45 per CIED) were applied from the Farapulse system to CIEDs (< 5 cm from the lead tip and < 15 cm from the generator). All devices were checked before and after PFA application for proper sensing and pacing functionality as well as for integrity of shock circuits in ICDs using a heart simulator. Moreover, devices were then interrogated for any spontaneous reprogramming, mode switching or other EMI effects. Results In total, 44 CIEDs were tested (16 pacemaker, 21 ICDs, 7 CRT-P/D) with 1980 PFA applications. There was no change in device settings, functionality and electrical parameters, and there was no macroscopic damage to the devices. The risk of damage to the electric components or leads on a patient-based analysis is 0/44 (95% CI 0–8%) and on a PFA pulse-based analysis is 0/1980 (95% CI 0–0.2%). Clinically relevant EMI appeared with oversensing and pacing inhibition but not tachycardia detection. Conclusions Bipolar PFA appears safe and does not result in damage to CIEDs or leads. Clinically relevant EMI does occur, but appropriate peri-procedural programming may mitigate this. In vivo studies are needed to confirm our findings. Graphical Abstract

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Section: Discussionsupporting

confidence: 85%

Pulsed field ablation in patients with cardiac implantable electronic devices: an ex vivo assessment of safety

Lennerz,

O’Connor,

Schaarschmidt

et al. 2024

J Interv Card Electrophysiol

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“…ICD shock and leads dislodgment. 4 Indeed, our pilot procedures with PFA applications in the SVC of AF patients with implanted devices confirmed the previous results without apparent additional risk because of energy application adjacent to the electrodes.…”

supporting

confidence: 86%

“…A recent study by a high‐volume center indicated that PFA is a safe and feasible method in patients with devices in the terms of alterations in pacing, sensing, or impedance parameters, inappropriate anti‐tachycardia pacing, and ICD shock and leads dislodgment. 4 Indeed, our pilot procedures with PFA applications in the SVC of AF patients with implanted devices confirmed the previous results without apparent additional risk because of energy application adjacent to the electrodes.…”

supporting

confidence: 86%

Superior vena cava isolation with pulsed field ablation in the presence of defibrillator leads

Tsiachris

Doundoulakis

Kordalis

et al. 2023

Journal of Arrhythmia

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“…Similar to the preclinical reports, no pulmonary vein stenosis was reported in any of the ten clinical publications utilizing PFA for atrial tachyarrhythmia catheter ablation [53][54][55][56][57][58][59][60][61][62] . The majority of these studies were completed by the same research group [Table 2], and most of the studies involved pre-ablation pulmonary vein imaging followed by repeat imaging at 3 months post-ablation.…”

Section: Clinical Pulmonary Vein Findings With Atrial Pfasupporting

confidence: 75%

Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation

Chinyere,

Mori,

Hutchinson

2024

Vessel Plus

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The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA’s effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.

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Pulsed field ablation-based pulmonary vein isolation in atrial fibrillation patients with cardiac implantable electronic devices: practical approach and device interrogation (PFA in CIEDs)

Cited by 14 publications

References 21 publications

Pulsed field ablation in patients with cardiac implantable electronic devices: an ex vivo assessment of safety

Pulsed field ablation in patients with cardiac implantable electronic devices: an ex vivo assessment of safety

Superior vena cava isolation with pulsed field ablation in the presence of defibrillator leads

Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation

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