Does PFA Reach the Vein of Marshall? | JACC Baran

Does pulsed field ablation (PFA) for pulmonary vein isolation affect structures beyond the pulmonary veins? Host Mitsuaki Sawano, MD, welcomes Yosuke Nakatani, MD (Gunma University) to discuss his recent JACC: Clinical Electrophysiology study examining the effects of PFA on the vein of Marshall (VoM). In this prospective study of 72 patients undergoing PFA using three different systems, a microelectrode catheter was positioned within the VoM to continuously record electrograms during ablation. PFA acutely altered VoM electrograms in 44% of patients, including complete elimination in 22%, but persistent VoM modification remained in only 14% by the end of the procedure. Importantly, the effect was strongly related to the distance between the PFA electrode and the VoM, suggesting that catheter geometry and proximity may matter more than energy strength alone. We discuss what these findings reveal about the unintended collateral effects of PFA, why most acute VoM effects rapidly recover, whether PFA could ever replace ethanol infusion for VoM ablation, and how a research idea conceived during Dr. Nakatani’s fellowship in Bordeaux ultimately became a first-in-human mechanistic study in Japan.