Details of adverse effects of AF ablation on CIEDs
In this study, no permanent pulse generator malfunctions and no
dislodgement of leads were observed. However, lead failure was observed
in 3 of 34 patients, with a sensing noise in 1 patient and a significant
impedance increase in 2 patients after SVCI. A 67-year-old man showed
sensing noises 2 months after the second SVCI. He had undergone
implantation of a dual chamber pacemaker 16 years before the first AF
ablation. No sensing noises were observed after the first SVCI. The
second session of the AF ablation was performed 14 months after the
first session. Electrical isolation of the SVC was successfully achieved
through RF application (maximum power, 25 W) to the lateral wall of the
SVC contiguous to the leads using a 3.5-mm open-irrigated tipped
catheter without contact force-sensing technology (Navistar ThermoCool
SF, Biosense Webster, Inc., Diamond Bar, CA). Thereafter, sensing noise
on an atrial pacing lead was observed. The diameter of the lead body
(Stelid BJ45D, ELA Medical, Montrouge, France) was 2.5 mm, and its outer
insulation material was silicone. Two patients showed an increase in
lead impedance. One was an impedance increase of the ventricular lead
(389–795 ohms) implanted 10 years before the ablation. The diameter of
the ventricular lead (Thinline Ⅱ Sterox EZ, Intermedics, TX, USA) was
1.7 mm, and its outer insulation material was polyurethane. The other
was an impedance increase of the atrial pacing lead (456–779 ohms)
implanted 4 years before the ablation. The diameter of the atrial lead
(CapSure Fix Novus, Medtronic, MN, USA) was 2 mm, and its outer
insulation was silicone. Both leads functioned normally; therefore, an
additional procedure such as lead exchange was not required.
Discussion
This study investigated whether
leads in the SVC might become obstacles in achieving electrical
isolation of the SVC and whether RF application during SVCI might damage
the leads. The main findings of this study were as follows: (i) SVCI was
successfully achieved in 91.2% of the study patients after the final
ablation procedure, (ii) lead parameters did not significantly differ
after SVCI; however, (iii) 3 lead failures (8.8% of the study patients)
were observed after SVCI.