Key result
PFA for AF causes less long-term autonomic disruption and neural damage than thermal ablation.
Why the study?
Ablation modalities differ in tissue specificity and collateral effects on the cardiac autonomic nervous system, but the autonomic effects of pulsed field ablation compared to thermal ablation in AF had not been systematically compared.
Does pulsed field ablation (PFA) reduce disruption of the autonomic nervous system compared to thermal ablation in patients with atrial fibrillation?
Does pulsed field ablation (PFA) reduce disruption of the autonomic nervous system compared to thermal ablation in patients with atrial fibrillation?
Pulsed field ablation causes less disruption to the cardiac autonomic nervous system than thermal ablation in patients with atrial fibrillation.
PFA may limit autonomic effects versus thermal ablation in AF ablation; extends meta-analytic data on differential neural outcomes.
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. 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.
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Graeger et al. (2025) studied this question. Pulsed field ablation for AF causes less autonomic nervous system disruption and neural damage than thermal ablation, with effects sustained mid- to long-term.
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