Safety of Catheter Ablation in Patients with Recently Implanted Cardiac
Implantable Electronic Device: A Five-Year Experience
Abstract
Introduction Catheter ablation (CA) can interfere with cardiac
implantable electronic device (CIED) function. The safety of CA in the 1
st year after CIED implantation/lead revision is
uncertain. Methods This single center, retrospective cohort
included patients who underwent CA between 2012-2017 and had a CIED
implant/lead revision within the preceding year. We assessed the
frequency of device/lead malfunction in this population.
Results We identified 1810 CAs in patients between 2012-2017,
with 170 CAs in 163 patients within a year of a CIED implant/lead
revision. Mean age 68 ± 12 years (68% men). Time between the CIED
procedure and CA was 158 ± 99 days. The CA procedures included AF
ablation (n=54, 32%), AV node ablation (n=41, 24%), atrial flutter
ablation (n=25, 15%), and PVC/VT ablations (n=24, 14%). The cumulative
frequency of lead dislodgement, significant CIED dysfunction, and/or
CIED-related infection following CA was (n=1/170, 0.6%). There was a
single atrial lead dislodgement (0.6%). There were no instances of
power-on-reset or CIED-related infection. Following CA, there was no
significant difference in RA or RV lead sensing (p=0.52 and 0.84
respectively) or thresholds (p=0.94 and 0.17 respectively). The RA
impedance slightly decreased post-CA from 474 ± 80 Ohms to 460 ± 73 Ohms
(p=0.002), as did the RV impedance (from 515 ± 111 Ohms to 497 ± 98
Ohms, p<.0001). Conclusions CA can be performed
within 1 year following CIED implantation/lead revision with a low risk
of CIED/lead malfunction or lead dislodgement. The ideal time to perform
CA after a CIED remains uncertain.