Comparative Effects of PFA Versus RFCA on Cardiac Autonomic Nerve System Function After PVI: A Prospective Cohort Study

INTRODUCTION: To evaluate the impact of pulsed-field ablation (PFA) and radiofrequency catheter ablation (RFCA) on cardiac autonomic nerve system (ANS) function after pulmonary vein isolation (PVI) by monitoring heart rate (HR) and heart rate variability (HRV) changes. METHODS: In this prospective cohort clinical study, patients with paroxysmal atrial fibrillation (AF) were enrolled consecutively into PFA or RFCA groups. HRV was assessed using the standard deviation of NN intervals (SDNN) and the standard deviation of the average NN intervals over 5-min periods (SDANN). HR, SDNN, and SDANN were measured before PVI and 3 months after PVI using 24-hour Holter monitoring. RESULTS: Acute electrical isolation was achieved in 100% of pulmonary veins (PVs) in the 72 patients. Over the 3-month follow-up, 36 of 36 patients in the PFA group and 36 of 36 patients in the RFCA group remained free from atrial arrhythmia episodes > 30 s. In the PFA group, there were no significant changes in HR, SDNN, and SDANN before and after PVI (all p > 0.05). The increase in HR in the PFA group was significantly lower than in the RFCA group (3.19 ± 10.50 vs. 10.86 ± 9.30 bpm; p = 0.0008). The decrease in HRV indices SDNN and SDANN in the PFA group was also significantly less than in the RFCA group (-10.72 ± 33.89 vs. -28.33 ± 30.55 ms; p = 0.012, -4.67 ± 32.55 vs. -22.03 ± 27.46 ms; p = 0.009). CONCLUSION: PFA results in less damage to cardiac ANS function and preserves more cardiac ANS function compared with RFCA during PVI for paroxysmal AF.