Vagal responses can occur during pulmonary vein isolation.

• A. True
• B. False
• C. Only During General Anesthesia
• D. Cannot Occur

Answer: (A)

Vagal responses during pulmonary vein isolation arise because the regions around the pulmonary vein ostia host a rich network of intrinsic autonomic nerves, including ganglionated plexi. When energy is delivered to these areas, it can stimulate or disrupt these autonomic fibers, triggering parasympathetic (vagal) activity. That can lead to sudden bradycardia, AV block, or hypotension during the procedure. This phenomenon can occur in both awake and sedated patients, so it is not restricted to general anesthesia or any specific condition. Therefore, the statement is true. If such a response occurs, clinicians typically pause ablation, monitor hemodynamics, and may use maneuvers like atropine or temporary pacing as needed.