Background <p>His-bundle ablation after pacemaker implantation is an effective means of rate control in patients with refractory atrial fibrillation (AF). Pacemaker insertion may be complicated by lead dislodgement, and accordingly, His-bundle ablation is commonly postponed to 4–8&#xa0;weeks after pacemaker implantation. Theoretically, His-bundle ablation itself could also lead to atrial or ventricular lead dislodgement. The precise rate of lead dislodgement in this context is unknown.</p> Objective <p>To determine atrial or ventricular lead dislodgements in patients with pacemaker implantation and His-bundle ablation.</p> Methods <p>Consecutive patients with AF who received His-bundle ablation between 01/2017 and 12/2022 were retrospectively studied. Two groups were defined. Group&#xa0;1 had de-novo pacemaker implantation and subsequent His-bundle ablation (at 4–8&#xa0;weeks after implantation). A&#xa0;second group of patients underwent His-bundle ablation &gt; 8&#xa0;weeks after pacemakers (group&#xa0;2) had been previously implanted for other indications. Pacemaker lead dislodgments were assessed as the primary endpoint prior to or immediately after His-bundle ablation and compared between the two groups.</p> Results <p>Data from 177 patients were collected. Of these, 110 underwent implantation 4–8&#xa0;weeks prior to ablation (group&#xa0;1) and 67 were in group&#xa0;2. Baseline patient and procedure characteristics were similar. Regarding the primary endpoint, no lead dislodgment was observed in either group. Any lead dislodgments observed occurred within 24&#xa0;h of pacemaker implantation and were unrelated to His-bundle ablation.</p> Conclusion <p>In patients with refractory persistent or permanent AF, His-bundle ablation is safe and no lead dislodgements were detected related to the ablation.</p>