Arrhythmias & electrophysiology
Impact of vagal effect on atrial and ventricular refractoriness and atrial fibrillation: A comparative analysis before and after cardioneuroablation
Authors' conclusion
Vagal activation is a potent atrial AF trigger, whereas ventricular refractoriness remains unchanged facing ECVS and/or CNA, underscoring chamber-specific autonomic effects and supporting the electrophysiological safety of ECVS and of CNA.
Study context
- Population
- Patients undergoing cardioneuroablation (CNA) for paroxysmal atrial fibrillation (AF) (with pulmonary vein isolation) or reflex syncope
- Participants
- 89 consecutive patients
- Comparison
- Extracardiac vagal stimulation (ECVS) before vs after cardioneuroablation
- Paroxysmal AFn = 76
- Reflex syncopen = 13
- Outcome
- AERP and VERP at baseline, during ECVS, after CNA, and after CNA during ECVS
Methodological detailsconsecutive patients, paired comparison
- Consecutive patients
- Paired comparison
Main finding
As reported in the abstract
- Right atrial AERP shortened with ECVS: 213.8 ± 25 to 100.6 ± 33 ms
- P < .001
- Left atrial AERP shortened with ECVS: 235.2 ± 32 to 143.3 ± 32 ms
- P < .001
- Ventricular effective refractory periods (VERP) in both ventricles unchanged across all stages
- P > .13
Further findings
AF inducibility (vagal AF induction test)
- Baseline
- 3.4%
- During ECVS
- 95.5%
- During ECVS after CNA
- 7.9%
- Cochran's Q
- P < 0.00001
- McNemar
- P < 0.00001
Original publication
Impact of vagal effect on atrial and ventricular refractoriness and atrial fibrillation: A comparative analysis before and after cardioneuroablation. Heart Rhythm. Published 13 October 2025. doi:10.
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