Arrhythmias & electrophysiology
Pulsed Field Ablation to Treat Atrial Fibrillation: Autonomic Nervous System Effects
Authors' conclusion
PFA has minimal effect on GP. Unlike with thermal ablation, the mechanism by which PFA treats atrial fibrillation is mediated solely by durable PVI.
Study context
- Population
- Patients undergoing pulmonary vein isolation (PVI) for AF20 additional prospective patients
- Participants
- 40 / 40 / 40
- Comparison
- Pulsed field ablation (PFA) vs cryoballoon ablation vs radiofrequency ablation
- Radiofrequency ablationn = 40
- Cryoballoonn = 40
- PFAn = 40
- Outcome
- Change in heart rate pre- vs post-PVI (retrospective phase); persistence of GP vagal effects (prospective phase)
- Follow-up
- 3 months
Methodological detailsretrospective phase, prospective phase
- Retrospective phase
- Prospective phase
Main finding
As reported in the abstract
Heart rate increase, baseline to 3 months
Radiofrequency ablation
8.9
± 11.4 · beats/min
Cryoballoon
11.1
± 9.4 · beats/min
PFA
−0.1
± 9.2 · beats/min
PFA vs Radiofrequency ablation: P = 0.01 · PFA vs Cryoballoon: P = 0.01
Further findings
Prospective phase: Ganglionated plexi (GP) vagal effects during and after PFA
- GP sites identified by pre-PFA high-frequency stimulation (HFS) (20 patients)
- 65
- Vagal effects in first PF applications
- 45%
- Vagal effects persisting through all applications
- 83%
- HFS post-PFA reproduced vagal effects in low-voltage tissue sites
- 29 of 38 sites (76%)
Original publication
Pulsed Field Ablation to Treat Atrial Fibrillation: Autonomic Nervous System Effects. JACC Clin Electrophysiol. Published 30 November 2022. doi:10.
Summarised from the published abstract; every number is checked against it