Arrhythmias & electrophysiologyCohort study
Transmurality and Autonomic Effects of Pulsed Field Ablation on the Mitral Isthmus
- prospective enrollment
Authors' conclusion
Across all 3 PFA platforms, endocardial ablation of the MI is not reliably transmural and does not ablate VOM parasympathetic innervation. VOM ethanol infusion can complete transmurality and denervation of the MI.
Study context
- Population
- Patients undergoing atrial fibrillation ablation with mitral isthmus ablation (endocardial to Vein of Marshall (VOM))patients undergoing atrial fibrillation ablation · FaraPulse 31 · PulseSelect 9 · Affera 31
- Participants
- 71 patients
- Exposure
- Transmurality of endocardial pulsed field ablation (PFA) at the mitral isthmus (MI) and its autonomic effects, using real-time epicardial VOM electrograms and VOM high-frequency stimulation
- FaraPulsen = 31
- PulseSelectn = 9
- Afferan = 31
Main finding
As reported in the abstract
Durable epicardial electrogram attenuation
- Overall
- 52.1%
Observational data: associations, not effects.
Further findings
Myocardial capture with VOM pacing persisted
- Myocardial capture with VOM pacing persisted — Overall
- 43.7%
- Myocardial capture with VOM pacing persisted: P <0.05
Pseudoblock (epicardial-only MI conduction and MI delays)
- Present
- 38%
MI block
- Achieved with PFA alone
- 45% (32/71)
- Additionally achieved with VOM ethanol infusion
- 38% (27/71)
- Cumulative
- 83% (59/71)
- Coronary sinus ablation used in the remaining
- 17% (12/71)
Parasympathetic response to VOM high-frequency stimulation after PFA
- Intact parasympathetic responses evidenced as atrioventricular block
Original publication
Transmurality and Autonomic Effects of Pulsed Field Ablation on the Mitral Isthmus. Circ Arrhythm Electrophysiol. Published 21 August 2026. doi:10.1161/circep.126.015125
Summarised from the published abstract; every number is checked against it