Arrhythmias & electrophysiologyRandomised controlled trial
Autonomic Alterations After Pulmonary Vein Isolation or Antiarrhythmic Drug Therapy
- randomized
- inverse probability-weighted mixed-effects models
Authors' conclusion
Cryoballoon-based pulmonary vein isolation results in significant sustained changes in the heart rate parameters related to autonomic function, compared with those randomized to antiarrhythmic drug therapy.
Study context
- Population
- Patients with paroxysmal treatment-naïve atrial fibrillation enrolled in the EARLY-AF trial, all with an implantable cardiac monitor (ICM) inserted at enrollment
- Participants
- 303 patients
- Comparison
- catheter ablation vs antiarrhythmic drug therapy
- cryoballoon ablationn = 154
- antiarrhythmic drug therapyn = 149
Primary result
As reported in the abstract
HRV, DHR and NHR at baseline · baseline
- no significant differences in heart rate variability (HRV), daytime heart rate (DHR), and nighttime heart rate (NHR) between randomized groups
Further findings
DHR, NHR and HRV · median follow-up of 1,143 days (Q1-Q3: 1,084-1,270 days)
- Patients randomized to ablation had reduced HRV and greater DHR and NHR
- differences persisting through 24 months for NHR and HRV and through 36 months for DHR
- These parameters did not differ from baseline in those randomized to antiarrhythmic drug therapy
Crossover from antiarrhythmic drug therapy to ablation
- patients crossing over from antiarrhythmic drug therapy to ablation exhibited autonomic parameters consistent with the treatment received
Post-treatment NHR and HRV and arrhythmia recurrence
- Post-treatment NHR and HRV were significantly associated with arrhythmia recurrence
Original publication
Autonomic Alterations After Pulmonary Vein Isolation or Antiarrhythmic Drug Therapy. JACC Clin Electrophysiol. Published 13 July 2026. doi:10.1016/j.jacep.2026.04.025
Summarised from the published abstract; every number is checked against it