Arrhythmias & electrophysiology
Autonomic Effects of Pulsed Field vs Thermal Ablation for Treating Atrial Fibrillation: Subanalysis of ADVENT
Authors' conclusion
PFA's effect on the autonomic nervous system was attenuated compared with thermal ablation.
Study context
- Population
- Patients with paroxysmal AF undergoing ablation, completing 6- and 12-month Holter monitoring
- Participants
- 379 patients
- Comparison
- Pulsed field ablation (PFA) vs thermal ablation
- PFAn = 194
- Thermaln = 185reference
- Primary endpoint
- Change in HR from baseline and HRV (SDNN, SDANN) as markers of autonomic function
- Follow-up
- 6 and 12 months
Methodological detailspivotal
- Pivotal
Primary result
As reported in the abstract
Increase in HR from baseline (ΔHR)
| Group | ΔHR 6 months | ΔHR 12 months |
|---|---|---|
| Thermal | 10.1 beats/min | 8.8 beats/min |
| PFA | 5.9 beats/min | 5.2 beats/min |
ΔHR 6 months
Thermal10.1 beats/min
PFA5.9 beats/min
ΔHR 12 months
Thermal8.8 beats/min
PFA5.2 beats/min
- Thermal vs PFA: P = 0.02 — 6 months
- Thermal vs PFA: P = 0.03 — 12 months
- Heart rate variability (HRV) (SDNN and SDANN) significantly lower at 6 and 12 months after thermal ablation vs PFA
- P < 0.01
Further findings
ΔHR, CB vs RF (thermal subgroups) · 6 and 12 months
- Increase in HR similar between CB and RF at 6 and 12 months
- P = 0.94 and 0.83
Original publication
Autonomic Effects of Pulsed Field vs Thermal Ablation for Treating Atrial Fibrillation: Subanalysis of ADVENT. JACC Clin Electrophysiol. Published 16 May 2024. doi:10.
Summarised from the published abstract; every number is checked against it