Abstract:
Background: Pulsed field ablation (PFA) is a novel technique for pulmonary vein isolation in atrial fibrillation management. Notably, asystole episodes of varying durations have been observed during electroporation, but the underlying mechanisms remain unclear.
Objective: This study hypothesizes that asystole during PFA is attributable to the activation of parasympathetic ganglia on the left atrium’s surface.
Methods: We conducted a study with 24 patients (67% male, 62.8 ± 11.0 years, BMI: 25.3 ± 5.6) suffering from paroxysmal atrial fibrillation. The order of pulmonary veins chosen for electroporation was randomized to avoid cumulative electroporation effects. PFA was performed and the duration of cardiac pauses post-electroporation was recorded for each application. To examine the impact of electroporation on the parasympathetic nervous system, transjugular vagal stimulation (TJVS) was performed from the right internal jugular before and after isolation of each vein, during sinus rhythm and atrial pacing. Continuous data were analyzed with Student’s t-tests or Mann-Whitney U tests as appropriate; nominal data were evaluated using chi-square or Fisher exact tests.