Previous work has shown TNFα upregulates NGF in NP and AF cells in vitro,41 so annular puncture with intradiscal injections of TNFα or PBS may facilitate nerve ingrowth and upregulation of neurotropic factors including NGF and VEGF, while anti‐TNFα injection mitigates nerve ingrowth and expression of these neurotropic factors. Here, TNF is linked to atrial fibrillation.