Abstract
PO-03-055 SHOCKING COMPLICATION: VENTRICULAR FIBRILLATION INDUCED BY PULSE FIELD ABLATION DURING ATRIAL FIBRILLATION ABLATION IN A PATIENT WITH ICD
Heart rhythm, Vol.22(4), pp.S360-S361
04/2025
DOI: 10.1016/j.hrthm.2025.03.976
Abstract
Background
Pulse field ablation (PFA) is increasingly used for AF ablation due to its safety and efficacy. However, rare complications such as VF induced by PFA application are not well characterized. This report highlights a unique case of PFA-induced VF in a patient who was undergoing AF ablation with an ICD.
Objective
To describe the occurrence of VF during PFA for AF ablation, examine contributing factors, and discuss implications for patient safety in the presence of ICD leads in proximity to PFA field.
Methods
We present a 47-year-old male with non-ischemic cardiomyopathy and paroxysmal AF who underwent PFA with the Farapulse system. The patient had previously experienced failure of a single-coil ICD lead due to failed defibrillation, which was successfully replaced with a dual-coil lead. During ablation, with the ICD in DDD mode and therapies disabled, PFA to the right superior pulmonary vein (RSPV) triggered VF requiring external defibrillation. Device interrogation and imaging were analyzed to determine the cause.
Results
VF induction coincided with PFA pulse delivery to the RSPV (Figure 1A and 1B). Device interrogation revealed ventricular pacing during the PFA pulse, with VF initiated by R-on-T phenomena (Figure 1C). CT imaging demonstrated proximity between the RV ICD lead and RSPV, implicating the SVC ICD coil as a potential induction coil (Figure 1D). No ventricular stimulation was observed during PFA delivery to left-sided pulmonary veins, supporting this hypothesis. Subsequent PFA application to the RSPV, excluding the vulnerable period, proceeded without complication.
Conclusion
This case highlights a rare but significant risk of VF during PFA in patients with ICD systems, particularly when SVC coil are in close proximity to the ablation site. PFA timing, relative to ventricular activation, and lead positioning may contribute to VF risk. These findings underscore the need for heightened awareness and precautions and careful timing of PFA energy delivery, to mitigate complications in such scenarios.
Details
- Title: Subtitle
- PO-03-055 SHOCKING COMPLICATION: VENTRICULAR FIBRILLATION INDUCED BY PULSE FIELD ABLATION DURING ATRIAL FIBRILLATION ABLATION IN A PATIENT WITH ICD
- Creators
- Ghazaleh GoldarCarlos E. VargasAaron SifuentesPeter D. FarjoPaari DominicSteven J. Bailin
- Resource Type
- Abstract
- Publication Details
- Heart rhythm, Vol.22(4), pp.S360-S361
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.hrthm.2025.03.976
- ISSN
- 1547-5271
- Language
- English
- Date published
- 04/2025
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984816012902771
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