Arrhythmias & electrophysiologyCohort study
Life-Threatening Delayed Myocardial Ischemia, Ventricular Arrhythmias, and SCD After Pulsed Field Ablation (PFA) of Atrial Fibrillation (AF)
- case series and systematic literature review
Authors' conclusion
Rare but life-threatening ischemic and malignant arrhythmic AEs associated with PFA underscore the need for structured surveillance and standardized reporting. A deeper understanding of the underlying mechanisms will be essential to identify patients at risk and guide future studies aimed at further improving the safety of PFA.
Study context
- Population
- Patients with AF who experienced ischemic adverse events (AEs) with delayed onset or arrhythmic AEs after PFA energy delivery between March 2023 and January 2026mean age 67 ± 10 years, 72% men, 72% with persistent AF, 51% with coronary artery disease · from literature review 30 · newly published extended case series (9 of 5,963 procedures (0.15%)) 9
- Participants
- 39 patients
Safety
Delayed ST-segment elevation · median of 16 minutes (Q1-Q3: 4-315 minutes) after last PF delivery
- Patients with delayed ST-segment elevation
- Seventeen
- Of the 17 with delayed ST-segment elevation, subsequently developed ventricular arrhythmia (VA)
- 11 (65%)
- Of the 17 with delayed ST-segment elevation, died
- 2 died (12%)
Location of ST-segment elevation (among the 13 patients with available 12-lead electrocardiograms)
- Inferior leads, of the 13 with 12-lead ECGs
- n = 10 [77%]
- Anteroseptal leads, of the 13 with 12-lead ECGs
- n = 1 [8%]
- Both, of the 13 with 12-lead ECGs
- n = 2 [15%]
VA and sudden cardiac death without preceding ST-segment elevation · median of 6 days (Q1-Q3: 2-18 days) after PFA
- VA in another patients
- 6
- Sudden cardiac death
- 16
Original publication
Summarised from the published abstract; every number is checked against it