Cryoballoon ablation and cardioversion using intracardiac defibrillation catheter for atrial fibrillation in a patient with deep brain stimulation

Deep brain stimulation (DBS) is a well-established therapy for drug-refractory Parkinson's disease. As 100–200 Hz signals from DBS are transmitted from the generator implanted subcutaneously in the anterior chest wall, there is a risk of central nervous system damage by radiofrequency energy or cardioversion. A 76-year-old female with a DBS was admitted for catheter ablation because of palpitation and syncope by paroxysmal atrial fibrillation. There may have been a risk of central nervous system damage and DBS electrode malfunction by radiofrequency energy and defibrillation shocks. In addition, cardioversion by an external defibrillator had the possibility to cause brain injury in patients with DBS. Therefore, pulmonary vein isolation by cryoballoon and cardioversion using an intracardiac defibrillation catheter were performed. Despite continued application of DBS during the procedure, no complications occurred. This is the first case report of cryoballoon ablation accompanied with intracardiac defibrillation under continued DBS. Cryoballoon ablation may be an alternative atrial fibrillation ablation method to radiofrequency catheter ablation for patients with DBS. Additionally, intracardiac defibrillation may reduce the risk of central nervous system damage and DBS malfunction. LEARNING OBJECTIVE: Deep brain stimulation (DBS) is a well-established therapy for Parkinson's disease. In patients with DBS, there is a risk of central nervous system damage by radiofrequency energy or cardioversion by an external defibrillator. Cryoballoon ablation may be an alternative atrial fibrillation ablation method to radiofrequency catheter ablation for patients with continued DBS. In addition, intracardiac defibrillation may reduce the risk of central nervous system damage and DBS malfunction.