Postcardiac injury syndrome after pulsed field ablation for atrial fibrillation: a case report

Background: Postcardiac injury syndrome (PCIS) is an uncommon inflammatory complication after catheter ablation for atrial fibrillation (AF). While pericarditis is well described following thermal ablation, reports after pulsed-field ablation (PFA) remain rare. Case summary: A 69-year-old man underwent pulmonary vein isolation using PFA for symptomatic paroxysmal AF. Four days later, he developed pleuritic chest pain, fever, and elevated inflammatory markers consistent with acute pericarditis. Despite initial improvement with non-steroidal anti-inflammatory drugs, he developed recurrent moderate-to-large pericardial and bilateral pleural effusions. Corticosteroids combined with colchicine led to resolution; however, relapses occurred during steroid tapering, necessitating more gradual withdrawal. At 12-month follow-up, the patient remained asymptomatic without recurrence of effusion or AF. Discussion: Although PFA is a non-thermal ablation modality, it may be associated with PCIS, warranting further studies to clarify the pathophysiological mechanisms involved.