What is a safe distance for delivering pulsed field ablation near coronary arteries?

Pulsed field ablation (PFA) has a unique tissue selectivity that minimizes damage to collateral structures. However, recent preclinical and clinical studies have highlighted an important risk of coronary artery (CA) spasm in response to PFA. 1 Higuchi S. Im S. Stillson C. et al. Effect of epicardial pulsed field ablation directly on coronary arteries. JACC Clin Electrophysiol. 2022; 8: 1486-1496 Crossref PubMed Scopus (4) Google Scholar , 2 Reddy V.Y. Petru J. Funasako M. et al. Coronary arterial spasm during pulsed field ablation to treat atrial fibrillation. Circulation. 2022; 146: 1808-1819 Crossref PubMed Scopus (16) Google Scholar , 3 Ladejobi A. Christopoulos G. Tan N. et al. Effects of pulsed electric fields on the coronary arteries in swine. Circ Arrhythm Electrophysiol. 2022; 15e010668 Crossref PubMed Scopus (4) Google Scholar A safe distance from the CA for delivering PFA has not been well defined. Therefore, we aimed to evaluate the distance over which a PFA electrical field would lead to CA spasm in an in vivo beating heart swine model.