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June 27, 2026EP EuropaceOpen Access

Practical safety thresholds for pulsed-field ablation near the sinus node and his bundle: an in vivo swine study

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Authors

MHM HondaMTM TakigawaMNM Negishi

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Overview

May reduce conduction injury via >5 mm HB distance and SN shot limits; leaves open prospective validation before practice change.

Key Points

  • To determine safety thresholds for pulsed-field ablation near the sinus node and His bundle in swine, focusing on electrophysiological responses.
  • Nine swine received 161 PFA applications around the sinus node and 67 around the His bundle.
  • Distance to the sinus node and His bundle was measured, and responses were classified based on changes in heart rhythm.
  • Statistical analyses determined predictive factors for safety thresholds.
  • Proximity to the sinus node and the P-EGM lead predicted sinus responses with AUC values of 0.877 and 0.835, respectively.
  • A cut-off distance of 5 mm showed high sensitivity for predicting persistent injury in both sinus node and His bundle responses.
  • Warning signs often appeared before persistent atrioventricular block, though some injuries occurred without prior warnings.

Cite This Study

Honda et al. (2026) studied this question.

synapsesocial.com/papers/6a3f97a5125782b61d86584bhttps://doi.org/10.1093/europace/euag105.243
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