Irreversible intracardiac defibrillator circuit damage induced by pulsed-field ablation: Mechanistic insights

Pulsed-field ablation (PFA) is a non-thermal modality that induces cardiomyocyte death via irreversible electroporation, achieving effective pulmonary vein isolation (PVI) while sparing surrounding tissues.1-2 Although PFA is generally considered safe in patients with cardiac implantable electronic devices (CIEDs),3-5 its strong electric fields may interfere with device function, potentially causing circuit damage or inappropriate responses.6 Recently, irreversible internal damage to an implantable cardioverter-defibrillator (ICD) was reported when PFA was delivered directly to the superior vena cava (SVC) coil of the ICD lead.