Arrhythmias & electrophysiologyResearch article
Impact of vagal effect on atrial and ventricular refractoriness and atrial fibrillation: A comparative analysis before and after cardioneuroablation
- paired human study
- consecutive patients
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. ECVS and vagal AF induction test provide objective, reproducible functional end points to guide ablation strategy, confirm atrial vagal denervation, and potentially reduce AF recurrence.
Study context
- Population
- Patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein isolation plus cardioneuroablation (CNA), and patients with reflex syncope undergoing CNA aloneconsecutive patients enrolled · paroxysmal AF undergoing pulmonary vein isolation plus CNA 76 · reflex syncope undergoing CNA alone 13
- Participants
- 89 patients
- Comparison
- AERP and ventricular effective refractory periods (VERP) measured at 4 stages: baseline, during extracardiac vagal stimulation (ECVS), after CNA, and after CNA during ECVS
Main finding
As reported in the abstract
AERP, right atrium
Further findings
| Outcome | baseline | during ECVS | after CNA | after CNA during ECVS |
|---|---|---|---|---|
| AERP, left atrium | 235.2 ± 32 ms | 143.3 ± 32 ms | Not reported in the abstract | Not reported in the abstract |
| AF inducibility (vagal AF induction test) | 3.4% | 95.5% | Not reported in the abstract | 7.9% |
- AERP, left atrium: P < .001
- AF inducibility (vagal AF induction test): Cochran's Q P < .00001
- AF inducibility (vagal AF induction test): McNemar P < .00001
AERP after CNA
- After CNA, AERP returned toward baseline and was no longer modified by ECVS
VERP in both ventricles
- remained unchanged across all stages
- P > 0.13
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:10.1016/j.hrthm.2025.10.011
Summarised from the published abstract; every number is checked against it