Pulsed-field ablation attenuated the rise in resting heart rate compared to thermal ablation (MD -7.57 bpm; 95% CI -11.66 to -3.48; p=0.0003) while maintaining comparable arrhythmia recurrence.
Meta-Analysis (n=800)
Does pulsed-field ablation attenuate autonomic perturbation (resting HR and HRV) compared to thermal ablation in patients with atrial fibrillation?
Pulsed-field ablation for atrial fibrillation results in less autonomic perturbation, preserving resting heart rate and heart rate variability better than thermal ablation, with similar efficacy.
Mean Difference: -7.57 (95% CI -11.66–-3.48)
p-value: p=0.0003
ABSTRACT Background Catheter ablation is an established therapy for atrial fibrillation (AF), with thermal ablation as a standard modality. Pulsed‐field ablation (PFA) is a nonthermal alternative that selectively ablates myocardium while sparing collateral tissue. Its comparative autonomic impact relative to thermal ablation remains unclear. The study aims to compare autonomic changes following PFA and thermal ablation in AF patients, focusing on heart rate (HR), heart rate variability (HRV), bradyarrhythmias, and arrhythmia recurrence. Methods We systematically searched MEDLINE, EMBASE, and Cochrane CENTRAL through August 2025 for randomized and nonrandomized studies reporting pre‐ and post‐ablation HR or HRV. Data were pooled using random‐effects or fixed‐effects models, depending on the presence of heterogeneity. Results Six studies (800 patients, PFA: 407, thermal: 393) were included. Thermal ablation was associated with a significantly greater rise in resting HR compared with PFA (mean difference ‐7.57 bpm, 95%CI: ‐11.66‐3.48, p = 0.0003; I 2 = 90% indicating high heterogeneity). HRV indices were consistently better preserved after PFA. SDNN at 12 months was approximately 150 ms with PFA versus 115 ms with thermal ablation (p95% of patients. Conclusions PFA attenuates autonomic perturbation relative to thermal ablation, preserving resting HR and HRV while maintaining comparable arrhythmia outcomes. These findings support PFA as an effective and autonomically sparing strategy for AF ablation.
Antoun et al. (Mon,) conducted a meta-analysis in Atrial Fibrillation (n=800). Pulsed-field ablation vs. Thermal ablation was evaluated on Rise in resting heart rate (MD -7.57, 95% CI -11.66 to -3.48, p=0.0003). Pulsed-field ablation attenuated the rise in resting heart rate compared to thermal ablation (MD -7.57 bpm; 95% CI -11.66 to -3.48; p=0.0003) while maintaining comparable arrhythmia recurrence.
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