Specific effects of Pulsed Field Ablation on the cardiac tissue, the nervous system and the conduction system in experimental and clinical studies.
9 affiliations
- 1Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Passac Cedex, France.
- 2Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan.
- 3Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
- 4Division of Cardiology, Sheba Medical Center, Ramat-Gan, Israel.
- 5Tel Aviv University Gray School of Medicine, Tel-Aviv, Israel.
- 6Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- 7Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA.
- 8Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
- 9Department of Medical Education, Boston Scientific Corporation, Madrid, Spain.
Abstract
Aims
Pulsed field ablation (PFA) has emerged as a novel ablation modality for the treatment of cardiac arrhythmias and has rapidly reshaped contemporary electrophysiology practice. This article provides a comprehensive analysis on the mechanisms underlying the specific effects of PFA on myocardial, neural tissue structures, and the cardiac conduction system, integrating biophysical principles with preclinical and clinical evidence relevant to contemporary electrophysiology practice.Methods and results
This document provides an exhaustive mechanistic explanation for the preferential effects of PFA on myocardium and the limits of the 'tissue-selectivity' concept. The complex interplay between cellular and tissue-level biophysics, biological responses, and tissue regenerative capacity that determines differential susceptibility to electroporation across tissues is analysed. Distinct patterns of lesion formation and maturation following PFA are also reviewed, highlighting the temporal and histopathological differences compared with radiofrequency ablation. Additionally, lesion formation in heterogeneous substrates is analysed, including fibrotic and adipose-rich myocardium, where local electric field distribution critically influences lesion durability.Conclusion
The article further examines the interaction between pulsed electric fields and neural tissue, with emphasis on the phrenic nerve and intrinsic cardiac autonomic nervous system. While nerve stimulation and transient reversible conduction disturbances produced by reversible electroporation can occur during ablation, permanent neural injury appears extremely rare in current clinical experience. Finally, this manuscript examines current understanding regarding the specific effects of PFA on the cardiac conduction system, which according to the limited available evidence appear strongly dependent on electric field dose and anatomical proximity.
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BibTeX
@article{duchateau2026specific,
title = {{Specific effects of Pulsed Field Ablation on the cardiac tissue, the nervous system and the conduction system in experimental and clinical studies.}},
author = {Josselin Duchateau and Iwanari Kawamura and Gurukripa N Kowlgi and Elad Maor and Moritz Nies and Christian W Zemlin and Tomás García-Sánchez and Samuel J Asirvatham},
journal = {Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology},
year = {2026},
month = oct,
doi = {10.1093/europace/euag208},
url = {https://europepmc.org/article/MED/42905917},
note = {CC BY},
}
RIS
TY - JOUR
TI - Specific effects of Pulsed Field Ablation on the cardiac tissue, the nervous system and the conduction system in experimental and clinical studies.
AU - Josselin Duchateau
AU - Iwanari Kawamura
AU - Gurukripa N Kowlgi
AU - Elad Maor
AU - Moritz Nies
AU - Christian W Zemlin
AU - Tomás García-Sánchez
AU - Samuel J Asirvatham
PY - 2026
DA - 2026/10/01
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
DO - 10.1093/europace/euag208
UR - https://europepmc.org/article/MED/42905917
AB - Aims Pulsed field ablation (PFA) has emerged as a novel ablation modality for the treatment of cardiac arrhythmias and has rapidly reshaped contemporary electrophysiology practice. This article provides a comprehensive analysis on the mechanisms underlying the specific effects of PFA on myocardial, neural tissue structures, and the cardiac conduction system, integrating biophysical principles with preclinical and clinical evidence relevant to contemporary electrophysiology practice.Methods and results This document provides an exhaustive mechanistic explanation for the preferential effects of PFA on myocardium and the limits of the 'tissue-selectivity' concept. The complex interplay between cellular and tissue-level biophysics, biological responses, and tissue regenerative capacity that determines differential susceptibility to electroporation across tissues is analysed. Distinct patterns of lesion formation and maturation following PFA are also reviewed, highlighting the temporal and histopathological differences compared with radiofrequency ablation. Additionally, lesion formation in heterogeneous substrates is analysed, including fibrotic and adipose-rich myocardium, where local electric field distribution critically influences lesion durability.Conclusion The article further examines the interaction between pulsed electric fields and neural tissue, with emphasis on the phrenic nerve and intrinsic cardiac autonomic nervous system. While nerve stimulation and transient reversible conduction disturbances produced by reversible electroporation can occur during ablation, permanent neural injury appears extremely rare in current clinical experience. Finally, this manuscript examines current understanding regarding the specific effects of PFA on the cardiac conduction system, which according to the limited available evidence appear strongly dependent on electric field dose and anatomical proximity.
SN - 1099-5129
SN - 1532-2092
ER -