Abstract
ABSTRACT
Background
Interactions between cardiac implantable electronic devices (CIEDs) and pulsed field ablation (PFA) have been studied mainly in the context of atrial ablation, whereas the effects of ventricular ablation using a dual‐energy lattice‐tip catheter on ventricular leads remain unclear.
Methods
This retrospective study involved 79 patients (mean age 60.9 ± 13.6 years) with an implantable cardioverter‐defibrillator or cardiac resynchronization therapy defibrillator who underwent ventricular ablation using a lattice‐tip catheter between February 2024 and November 2025. Pacing thresholds were assessed before, immediately after, and 3 months after ablation and standardized to a pulse width of 0.4 ms using the Lapicque–Weiss model. Marked acute threshold elevation was defined as an increase in pacing threshold of ≥ 1.0 V immediately after ablation. The anatomical relationship between ablation sites and ventricular lead locations was assessed based on the American Heart Association 17‐segment model of the left ventricle and classified as corresponding when ablation involved the same or opposing ventricular region as the lead location, adjacent when ablation involved a directly adjacent region, and remote otherwise.
Results
Marked acute pacing‐threshold elevation occurred in 5 of 79 right ventricular (RV) leads (6.3%) and 2 of 22 evaluable left ventricular (LV) leads (9.1%). For RV leads, marked threshold elevation occurred in 4 of 14 patients (28.6%) in the corresponding group, 1 of 19 (5.3%) in the adjacent group, and none of 46 (0%) in the remote group. When threshold change was analyzed as a continuous variable, the acute increase was significantly greater in the corresponding group (+ 0.74 V; 95%CI 0.465–1.018) than in the adjacent (+ 0.31 V; 95%CI 0.076–0.550) and remote (+ 0.007 V; 95%CI − 0.145–0.160) groups. For LV leads, the pacing threshold increased significantly after ablation involving the corresponding segment (+ 0.71 V; 95%CI 0.167–1.245), although the overall association between anatomical relationship and threshold change was not significant. At 3 months, pacing thresholds in the corresponding groups were not significantly different from baseline for either RV or LV leads.
Conclusion
Marked acute pacing‐threshold elevation was observed in both RV and LV leads after ventricular arrhythmia ablation using a dual‐energy lattice‐tip catheter. However, both RV and LV thresholds were no longer significantly different from baseline at 3 months. These findings suggest the importance of considering the anatomical relationship between ablation sites and CIED leads and of careful peri‐procedural assessment of lead function during ventricular ablation.