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
October 1, 2026 · via Europe PMC
Specific effects of Pulsed Field Ablation on the cardiac tissue, the nervous system and the conduction system in experimental and clinical studies.
Duchateau J, Kawamura I, Kowlgi GN, Maor E, Nies M, Zemlin CW, García-Sánchez T, Asirvatham SJ.
AI summary — for doctors, generated from the abstract only
PFA has distinct, not fully tissue-selective effects on myocardium, nerves and the conduction system, driven by electric field and tissue properties.
What was studied
Mechanistic review integrating biophysics with preclinical and clinical evidence.
Key findings
- Susceptibility to electroporation differs by tissue and regenerative capacity.
- Lesion formation and maturation differ from radiofrequency, and fibrotic or fatty substrate alters durability.
- Interactions with phrenic nerve and intrinsic cardiac autonomic nervous system are examined.
Clinical relevance
Helps electrophysiologists understand the limits of PFA 'tissue selectivity' when planning ablation.
Who should care
Limitations
Narrative review whose abstract is truncated.
Do not assume complete tissue selectivity; consider nerve and conduction effects.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
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.
DOI
10.1093/europace/euag208
PMID
42905917
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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