Arrhythmias & electrophysiologyMeta-analysis
Peri-procedure and Mid-Long Term Effects of Pulsed Field Ablation vs. Thermal Ablation (Cryo- or Radiofrequency) on Autonomic Nervous System Function in Atrial Fibrillation: A Systematic and Quantitative Pooled-Analysis with Potential Implications for Patient Selection (The PULSE-COLD-HEAT-ANS Collaboration)
- Systematic review and meta-analysis
- pooled analysis
Authors' conclusion
PFA-based pulmonary vein isolation in patients with AF results in a smaller post-procedural IHR and less S100B release, suggesting reduced neural damage and less disruption of the autonomic nervous system compared to TA.
Study context
- Population
- Patients with atrial fibrillation (AF) undergoing ablation; comparative studies from PubMed and Embase to 5 April 2025
- Participants
- 1,007 patients · 8 studies
- Comparison
- Pulsed field ablation (PFA) vs thermal ablation
- Outcome
- Increase in heart rate (IHR) after ablation
Pooled result
As reported in the abstract
Increase in heart rate
P < 0.00001
Further pooled results
Increase in serum S100B (marker of neural injury) · significantly less pronounced after PFA
P < 0.00001
Increase in heart rate at midterm (3-6 months) and long-term (12 months) follow-up, and by age, sex and thermal ablation (TA) modality
- Difference persisted at midterm and long-term follow-up and was consistent across age, sex and TA modalities (cryoballoon vs radiofrequency)
Original publication
Peri-procedure and Mid-Long Term Effects of Pulsed Field Ablation vs. Thermal Ablation (Cryo- or Radiofrequency) on Autonomic Nervous System Function in Atrial Fibrillation: A Systematic and Quantitative Pooled-Analysis with Potential Implications for Patient Selection (The PULSE-COLD-HEAT-ANS Collaboration). Europace. Published 29 September 2025. doi:10.1093/europace/euaf242
Summarised from the published abstract; every number is checked against it