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.