Efficacy and Drug-Related Complications of Anticholinergic Drugs for Vagal Reaction Prevention During Pulsed Field Ablation

Vetta, G; Della Rocca, DG; Magnocavallo, M; Richard-Vitton, R; Almorad, A; Betancur, A; Sorgente, A; Polselli, M; Marcon, L; Mohanty, S; Del Monte, A; Lombardo, I; Pannone, L; Mouram, S; Stroker, E; Gianni, C; La Fazia, VM; Bianchi, S; Doundoulakis, I; Overeinder, I; Audiat, C; Nakasone, K; Bala, G; Combes, S; Sarkozy, A; Sieira, J; Boveda, S; Rossi, P; Natale, A; de Asmundis, C; Chierchia, GB; HRMC Investigators

doi:10.1016/j.jacep.2025.04.015

Arrhythmias & electrophysiology

Efficacy and Drug-Related Complications of Anticholinergic Drugs for Vagal Reaction Prevention During Pulsed Field Ablation

JACC Clin ElectrophysiolPublished 24 Apr 2025prospective, multicenter study

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Authors' conclusion

Prophylactic AC drug administration effectively prevented clinically relevant VRs in patients undergoing PVI with PFA. Both AC drugs were equally highly effective, but ATP showed a significantly higher rate of drug-induced adverse events.

Study context

Population: Patients with atrial fibrillation undergoing first-time pulmonary vein isolation (PVI) with pulsed field ablation (PFA) via a pentaspline PFA catheterGlycopyrrolate (GLY) 80 · atropine (ATP) 80 · noAC 80
Participants: 240 enrolled patients

Exposure: GLY vs ATP for vagal responses (VR) prophylaxis, compared with patients without prophylactic anticholinergic (AC) drug administration
Group GLYn = 80
Group ATPn = 80
Group noACn = 80
Outcome: Intraprocedural VRs (all patients)

Methodological detailsconsecutive patients, 4 centers, April 2023 to March 2024

Consecutive patients
4 centers
April 2023 to March 2024

Main finding

As reported in the abstract

Intraprocedural VRs observed

65 patients

27.1%

Observational data: associations, not effects.

Further findings

Overall VRs

Group GLY7.5%

Group ATP11.3%

Group noAC62.5%

Asystole

Group GLY1.3%

Group ATP2.5%

Group noAC33.8%

Need for temporary backup pacing

Group GLY1.3%

Group ATP5.0%

Group noAC23.8%

Overall VRs: P < 0.001
Asystole: P < 0.001
Need for temporary backup pacing: P < 0.001

Safety

Outcome	Group GLY	Group ATP	Group noAC
Overall drug-related adverse eventsSignificantly higher with ATP	0%	8.8%	Not reported in the abstract	Group noAC: not reported in the abstract
Drug-induced atrial fibrillationSignificantly higher with ATP	0%	5%	Not reported in the abstract	Group noAC: not reported in the abstract

Overall drug-related adverse events: P = 0.007
Drug-induced atrial fibrillation: P = 0.043

Reference

Authors: Vetta G, Della Rocca DG, Magnocavallo M, Richard-Vitton R, Almorad A, Betancur A, et al.
All 32 authors
Vetta G, Della Rocca DG, Magnocavallo M, Richard-Vitton R, Almorad A, Betancur A, Sorgente A, Polselli M, Marcon L, Mohanty S, Del Monte A, Lombardo I, Pannone L, Mouram S, Stroker E, Gianni C, La Fazia VM, Bianchi S, Doundoulakis I, Overeinder I, Audiat C, Nakasone K, Bala G, Combes S, Sarkozy A, Sieira J, Boveda S, Rossi P, Natale A, de Asmundis C, Chierchia GB, HRMC Investigators
Journal: JACC: Clinical Electrophysiology
Published: 24 Apr 2025
DOI: 10.1016/j.jacep.2025.04.015
PubMed: 40392662

Topic: Arrhythmias & electrophysiology

Exposure definitions

Group GLY: Intravenous GLY 0.2 mg administered prophylactically before transseptal access
Group ATP: Intravenous ATP 1 mg administered prophylactically before transseptal access

Original publication

Efficacy and Drug-Related Complications of Anticholinergic Drugs for Vagal Reaction Prevention During Pulsed Field Ablation. JACC Clin Electrophysiol. Published 24 April 2025. doi:10.1016/j.jacep.2025.04.015

Read the original article ↗

Summarised from the published abstract; every number is checked against it