First use of pulsed field ablation in a patient with a deep brain stimulator: a case report.

Background: Pulmonary vein isolation for atrial fibrillation (AF) in patients with implanted neurostimulation devices is challenging, as established energy sources, such as radiofrequency (RF) ablation, are generally not recommended in these patients due to the risk of device interference. Pulsed field ablation (PFA) for AF offers relative myocardial selectivity and a potentially improved safety profile. However, data on its use in patients with implanted neurostimulation devices are lacking. Case summary: A 66-year-old woman with paroxysmal AF was referred to our centre for catheter ablation. Years earlier, a deep brain stimulator (DBS) had been implanted to control severe fasciculations. As RF ablation is not recommended in such patients and given the patient's multiple comorbidities, a single-shot ablation strategy was chosen. After selective pulmonary vein angiography revealed a large left common pulmonary vein (LCPV), PFA using a pentaspline catheter was selected, as this approach allows effective treatment of a LCPV with short procedure times and a favourable safety profile. The DBS was deactivated prior to the procedure and ablation was performed without complications. After the procedure, the DBS was reactivated and showed no evidence of device malfunction. Discussion: This is the first reported case that demonstrates the feasibility of PFA in a patient with an implanted DBS. Temporary deactivation of the neurostimulation device and careful multidisciplinary planning allowed successful ablation without device dysfunction or interference. These findings suggest that, with appropriate precautions, PFA may represent a viable ablation strategy in selected patients with implanted neurostimulation systems.