Potential Mechanisms of Transient Sinus Node Dysfunction During Pulsed Field Ablation: Autonomic Activation, Direct Sinus Node Effects, and Possible Sinoatrial Nodal Artery Vasospasm

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]