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June 27, 2026EP EuropaceOpen Access

Practical safety thresholds for pulsed-field ablation near the sinus node and his bundle: an in vivo swine study

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Why the study?

Quantitative safety margins and practical safety strategies for pulsed-field ablation near the sinus node and His bundle remain undefined as ablation expands to non-pulmonary vein targets.

Population

Nine swine undergoing pulsed-field ablation applications

Comparison

161 applications around the SN and 67 around the HB

Design

In vivo swine study

Follow-up

30 minutes

Authors

MHM HondaMTM TakigawaMNM Negishi

Discussion

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Overview

May reduce conduction injury via >5 mm HB distance and SN shot limits; leaves open prospective validation before practice change.

Key Points

  • To determine safety thresholds for pulsed-field ablation near the sinus node and His bundle in swine, focusing on electrophysiological responses.
  • Nine swine received 161 PFA applications around the sinus node and 67 around the His bundle.
  • Distance to the sinus node and His bundle was measured, and responses were classified based on changes in heart rhythm.
  • Statistical analyses determined predictive factors for safety thresholds.
  • Proximity to the sinus node and the P-EGM lead predicted sinus responses with AUC values of 0.877 and 0.835, respectively.
  • A cut-off distance of 5 mm showed high sensitivity for predicting persistent injury in both sinus node and His bundle responses.
  • Warning signs often appeared before persistent atrioventricular block, though some injuries occurred without prior warnings.

Cite This Study

Honda et al. (2026) studied this question.

synapsesocial.com/papers/6a3f97a5125782b61d86584bhttps://doi.org/10.1093/europace/euag105.243
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Novel focal-bipolar pulsed field ablation for treatment of accessory pathways located near the bundle of his2026
  2. 2Preclinical evaluation of a novel single‐shot pulsed field ablation system for pulmonary vein and atrial ablation2023 · 16 citations
  3. 3Impact of Pulsed Electric Field Ablation on His Bundle Conduction: A Preclinical Canine Study2024 · 6 citations
  4. 4First-in-human concomitant nanosecond pulsed field ablation of atrial fibrillation2026
  5. 5Monopolar biphasic focal pulsed field ablation directly at the atrioventricular junction and from within the non-coronary cusp: The PFA-CONDUCT study2026