Effects of radiofrequency catheter ablation on patients with permanent pacemakers.

Abstract

The objective of this study was to assess the effects of radiofrequency energy application on implanted pacemaker functions. Radiofrequency (RF) catheter ablation may cause pacemaker dysfunction due to electromagnetic interferences. The effects of RF on pacemaker behavior were studied in a series of 38 pacemakers, implanted 18 +/- 26 months prior to a RF procedure using either a right ventricular approach (AV node ablation, n = 35) or a left ventricular approach (left concealed accessory pathway ablation, n = 1; VT ablation, n = 2). The 38 patients (mean age 65 +/- 9 years) included 20 men and 18 women. Before energy applications, the 23 different pacemaker models were programmed to the VVI mode at the lowest available rate. The continuous surface ECG was recorded throughout the procedure. Thorough testing of the devices was performed before and after each RF delivery. Unusual pacemaker responses occurred in 20 of the 38 cases studied (53%). The impact of RF delivery was unpredictable, and variable dysfunctions were observed at different times for a given patient or could vary for a given model. Unusual pacemaker responses included pacemaker inhibition (n = 8), untoggled backup mode (n = 3), electromagnetic interference noise mode (n = 3), temporary RF-induced pacemaker tachycardia (n = 2), erratic behavior (n = 1), oversensing of RF onset and offset (n = 8), and transient loss of ventricular capture, (n = 1). Postablation, most devices automatically toggled back to full functionality. The three devices in the untoggled backup mode had to be reprogrammed to obtain normal operations. At the end of the procedure, pacing thresholds remained unchanged in all but one patient, in whom the increase in ventricular threshold was due to a nicked lead. In conclusion, implanted pacemakers frequently exhibit transient, unpredictable responses to RF energy application. Although all pacemaker functions were restored postablation, some devices had to be reset manually. The anomalies observed during the RF application argue for the simultaneous use of an external pacemaker in pacing-dependent patients.

AI evidence extraction

Main findings

In 20/38 cases (53%), unusual pacemaker responses occurred during RF energy application, including inhibition, backup mode, noise mode, temporary RF-induced pacemaker tachycardia, oversensing, and transient loss of capture. Most devices returned to full functionality postablation, but three required reprogramming; pacing thresholds were unchanged except in one case attributed to a nicked lead.

Outcomes measured

• Pacemaker dysfunction/abnormal responses during RF delivery (e.g., inhibition, backup mode, noise mode, tachycardia, oversensing, loss of capture)
• Need for device reprogramming/reset postablation
• Pacing threshold changes

Limitations

• Series design; randomization/control group not described
• RF exposure parameters (e.g., frequency, power, duration) not reported in abstract
• Heterogeneous pacemaker models (23 models) and ablation approaches; effects described as unpredictable

Suggested hubs

• medical-devices-pacemakers (0.9)
  Study evaluates electromagnetic interference effects of RF energy application on implanted pacemaker function during catheter ablation.

{
    "study_type": "other",
    "exposure": {
        "band": "RF",
        "source": "medical procedure (radiofrequency catheter ablation)",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": null
    },
    "population": "Patients with implanted permanent pacemakers undergoing RF catheter ablation",
    "sample_size": 38,
    "outcomes": [
        "Pacemaker dysfunction/abnormal responses during RF delivery (e.g., inhibition, backup mode, noise mode, tachycardia, oversensing, loss of capture)",
        "Need for device reprogramming/reset postablation",
        "Pacing threshold changes"
    ],
    "main_findings": "In 20/38 cases (53%), unusual pacemaker responses occurred during RF energy application, including inhibition, backup mode, noise mode, temporary RF-induced pacemaker tachycardia, oversensing, and transient loss of capture. Most devices returned to full functionality postablation, but three required reprogramming; pacing thresholds were unchanged except in one case attributed to a nicked lead.",
    "effect_direction": "harm",
    "limitations": [
        "Series design; randomization/control group not described",
        "RF exposure parameters (e.g., frequency, power, duration) not reported in abstract",
        "Heterogeneous pacemaker models (23 models) and ablation approaches; effects described as unpredictable"
    ],
    "evidence_strength": "low",
    "confidence": 0.7800000000000000266453525910037569701671600341796875,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "radiofrequency",
        "catheter ablation",
        "electromagnetic interference",
        "pacemaker",
        "device malfunction",
        "oversensing",
        "pacing threshold"
    ],
    "suggested_hubs": [
        {
            "slug": "medical-devices-pacemakers",
            "weight": 0.90000000000000002220446049250313080847263336181640625,
            "reason": "Study evaluates electromagnetic interference effects of RF energy application on implanted pacemaker function during catheter ablation."
        }
    ]
}

Comments

Log in to comment.

No comments yet.