Safety of fluoroless radiofrequency catheter ablation for atrial fibrillation in patients with pre‐existing cardiac implantable electronic device: A single‐center study

Abstract

AbstractBackgroundRadiofrequency catheter ablation (RFA) for atrial fibrillation (AF) is being increasingly performed without fluoroscopy. This study aims to determine the safety of fluoroless RFA for patients with pre‐existing cardiac implantable electronic devices (CIED).MethodsThis is a single‐center, single‐operator, retrospective, observational study of 225 consecutive fluoroless RFA procedures for AF from June 1, 2019 to June 1, 2022. All procedures were performed with intracardiac echocardiography (ICE) support. Patients with pre‐existing CIED were extracted from the database. Each CIED was interrogated at the start and end of each procedure and at 30‐day follow‐up. Pre‐ and post‐procedure CIED interrogations were compared for any change in device or lead parameters. Patients were tracked for any subsequent device malfunction.ResultsOut of 225 fluoroless AF ablations, 25 (10.2%) had pre‐existing CIED (14 dual‐chamber pacemakers, three dual‐chamber defibrillators, three single‐chamber defibrillators, one single chamber pacemaker, and four biventricular devices). Mean patient age was 71 ± 6 years. The mean duration of indwelling CIED was 1804 ± 1645 days (range: 78–6267 days). One (4%) patient had lead‐related fibrin on ICE imaging. There was no significant difference in lead(s) threshold, impedance, or sensing post procedure or at 30‐day follow‐up compared to pre procedure. None of the patients required lead revision. There were no intra‐ or post‐op thromboembolic events or subsequent device infection. One patient underwent CIED extraction after 11 months for an unrelated secondary device infection.ConclusionsRadiofrequency catheter ablation for AF can be safely performed without fluoroscopy in patients with pre‐existing CIED.