Arrhythmias & electrophysiology
Pulsed field ablation of the right superior pulmonary vein prevents vagal responses via anterior right ganglionated plexus modulation
Authors' conclusion
PVI with PFA frequently induced vagal responses when initiated from the LSPV. Nevertheless, an RSPV-first approach promoted transient HR increase and reduced vagal response occurrence.
Study context
- Population
- Paroxysmal AF patients undergoing pulmonary vein isolation (PVI) with pulsed field ablation (PFA)
- Participants
- 80 patients
- Exposure
- Right superior pulmonary vein (RSPV)-first vs LSPV-first PVI with PFA
- RSPV-firstn = 40
- LSPV-firstn = 40reference
- Outcome
- Intraprocedural vagal responses
Methodological detailsconsecutive patients, sequential allocation (first 40 vs last 40)
- Consecutive patients
- Sequential allocation (first 40 vs last 40)
Main finding
As reported in the abstract
Vagal responses
P < 0.001
Observational data: associations, not effects.
Further findings
Temporary pacing needed
P = 0.003
Acute HR increase with RSPV isolation
- Similar acute HR increase in the 2 groups (13 ± 11 bpm vs 15 ± 12 bpm)
- P = 0.3
Residual changes in HR or extracardiac vagal stimulation (ECVS) response at end of procedure vs baseline
- No significant residual changes in HR or ECVS response in both groups
- all P >.05
Safety
Temporary pacing needed
P = 0.003
Original publication
Pulsed field ablation of the right superior pulmonary vein prevents vagal responses via anterior right ganglionated plexus modulation. Heart Rhythm. Published 28 January 2024. doi:10.
Summarised from the published abstract; every number is checked against it