Evidence map›Paper›PMID 42905917›Full record

ReviewEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026

Specific effects of Pulsed Field Ablation on the cardiac tissue, the nervous system and the conduction system in experimental and clinical studies.

Josselin Duchateau, Iwanari Kawamura, Gurukripa N Kowlgi, Elad Maor, Moritz Nies, Christian W Zemlin, Tomás García-Sánchez, Samuel J Asirvatham

Abstract readReview
In one paragraph

Review in 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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Josselin DuchateauHôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Passac Cedex, France.ORCID 0000-0002-4367-1117
Iwanari KawamuraDepartment of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan.ORCID 0000-0002-6431-9278
Gurukripa N KowlgiDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.ORCID 0000-0002-0913-3497
Elad MaorDivision of Cardiology, Sheba Medical Center, Ramat-Gan, Israel.ORCID 0000-0002-5087-0464
Moritz NiesDepartment of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.ORCID 0000-0002-9384-4151
Christian W ZemlinDivision of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA.ORCID 0000-0001-5834-5544
Tomás García-SánchezDepartment of Medical Education, Boston Scientific Corporation, Madrid, Spain.ORCID 0000-0002-1115-0683
Samuel J AsirvathamDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.ORCID 0000-0001-9835-5536

Funding

Boston Scientific
6 · The paper itself

Abstract

aimsPulsed 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

resultsThis 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.

conclusionThe 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.

Indexed as

Arrhythmias, CardiacHeartHeart Conduction SystemMyocardiumAnimalsHumansIrreversible Electroporation TherapyTreatment OutcomeConduction systemHeterogeneous substrateLesion formationPhrenic nervePreferential myocardial ablationPulsed field ablationTissue selectivityVagal responses

Identifiers

PMID42905917
PMCPMC13685782

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.