TY - JOUR
T1 - 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
T2 - A Systematic and Quantitative Pooled-Analysis with Potential Implications for Patient Selection (The PULSE-COLD-HEAT-ANS Collaboration)
AU - Graeger, Sebastian
AU - Narayan, Sanjiv M.
AU - Meyer, Christian
AU - Linz, Dominik
AU - Rillig, Andreas
AU - Zylla, Maura M.
AU - Ebrahimi, Ramin
AU - Duru, Firat
AU - Perrotta, Laura
AU - Neven, Kars
AU - Heeger, Christian Hendrik
AU - Ruwald, Martin H.
AU - Futyma, Piotr
AU - Mulder, Bart A.
AU - Mirzayeva, Gozal
AU - Kiuchi, Márcio Galindo
AU - Martinek, Martin
AU - Pürerfellner, Helmut
AU - Boveda, Serge
AU - Yin, Yuehui
AU - Yang, Gang
AU - Liu, Hailei
AU - Chen, Minglong
AU - Schmidt, Boris
AU - Chun, Julian K.R.
AU - Qin, Mu
AU - Hou, Xumin
AU - Liu, Xu
AU - Zhong, Jingquan
AU - Chen, Shaojie
N1 - Publisher Copyright:
© 2025 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2025/11
Y1 - 2025/11
N2 - Aims Ablation modalities differ in their mechanisms of action, tissue specificity, and collateral effects - particularly on the cardiac autonomic nervous system. This study aimed to compare the autonomic effects of pulsed field ablation (PFA) vs. thermal ablation (TA) in patients with atrial fibrillation (AF) through a pooled analysis. Methods and results A systematic search of PubMed and Embase was conducted through 5 April 2025, to identify comparative studies. The primary outcome was increase in heart rate (IHR) after ablation, and the secondary outcome was increase in serum S100B (IS100B), a marker of neural injury. Eight studies involving 1007 AF patients were included (mean age: 63.39 ± 10.75 years; 36.3% female; maximum follow-up: 12 months). Baseline characteristics, including the use of antiarrhythmic drugs, were similar between the PFA and TA groups. Pooled analysis showed that PFA was associated with a significantly lower IHR compared to TA (PFA: 4.41 ± 8.86 bpm vs. TA: 10.81 ± 10.46 bpm; P < 0.00001). This difference persisted at midterm (3-6 months) and long-term (12 months) follow-up and remained consistent across age, sex, and different TA modalities (cryoballoon vs. radiofrequency). Correspondingly, the IS100B was significantly less pronounced after PFA (PFA: 33.27 ± 9.46 pg/mL vs. TA: 97.53 ± 31.88 pg/mL; P < 0.00001). 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. These effects are sustained through mid- to long-term follow-up and may have potential implications for patient selection and individualized ablation strategies.
AB - Aims Ablation modalities differ in their mechanisms of action, tissue specificity, and collateral effects - particularly on the cardiac autonomic nervous system. This study aimed to compare the autonomic effects of pulsed field ablation (PFA) vs. thermal ablation (TA) in patients with atrial fibrillation (AF) through a pooled analysis. Methods and results A systematic search of PubMed and Embase was conducted through 5 April 2025, to identify comparative studies. The primary outcome was increase in heart rate (IHR) after ablation, and the secondary outcome was increase in serum S100B (IS100B), a marker of neural injury. Eight studies involving 1007 AF patients were included (mean age: 63.39 ± 10.75 years; 36.3% female; maximum follow-up: 12 months). Baseline characteristics, including the use of antiarrhythmic drugs, were similar between the PFA and TA groups. Pooled analysis showed that PFA was associated with a significantly lower IHR compared to TA (PFA: 4.41 ± 8.86 bpm vs. TA: 10.81 ± 10.46 bpm; P < 0.00001). This difference persisted at midterm (3-6 months) and long-term (12 months) follow-up and remained consistent across age, sex, and different TA modalities (cryoballoon vs. radiofrequency). Correspondingly, the IS100B was significantly less pronounced after PFA (PFA: 33.27 ± 9.46 pg/mL vs. TA: 97.53 ± 31.88 pg/mL; P < 0.00001). 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. These effects are sustained through mid- to long-term follow-up and may have potential implications for patient selection and individualized ablation strategies.
KW - Atrial fibrillation
KW - Autonomic nervous system
KW - Catheter ablation
KW - Cryoballoon
KW - Heart rate
KW - Pulsed field ablation
KW - Radiofrequency
KW - S100B
UR - https://www.scopus.com/pages/publications/105020780951
U2 - 10.1093/europace/euaf242
DO - 10.1093/europace/euaf242
M3 - Article
C2 - 41020496
AN - SCOPUS:105020780951
SN - 1099-5129
VL - 27
JO - Europace
JF - Europace
IS - 11
M1 - euaf242
ER -