Key result
Pulsed field ablation transiently modulates intrinsic cardiac autonomic tone and ganglionated plexi during AF ablation.
Why the study?
Pulsed field ablation can transiently affect the intrinsic cardiac autonomic nervous system and potentially cause transient sinus node dysfunction, but the mechanisms are not fully understood.
Discusses potential mechanisms of transient sinus node dysfunction during pulsed field ablation for atrial fibrillation, including autonomic activation and possible vasospasm.
Monitor for transient sinus slowing during PFA near the RAGP; these cases leave open the dominant mechanism.
Pulsed field ablation (PFA) has emerged as an important technology for atrial fibrillation (AF) ablation because of its myocardial selectivity and favorable safety profile compared with thermal ablation.[1–3] Beyond myocardial injury, PFA can transiently affect the intrinsic cardiac autonomic nervous system (ANS), particularly the ganglionated plexi (GPs) surrounding the pulmonary veins and atria.[4–7] The right anterior ganglionated plexus (RAGP), located near the right superior pulmonary vein (RSPV) and superior vena cava, has important connections with the sinoatrial (SA) node and contributes to autonomic regulation of sinus rate.[6,8]
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Costa et al. (2026) conducted a review in atrial fibrillation. Pulsed field ablation was evaluated. Pulsed field ablation can transiently affect the intrinsic cardiac autonomic nervous system and ganglionated plexi, contributing to autonomic regulation of sinus rate during atrial fibrillation ablation.
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