Key result
Pulsed field ablation for paroxysmal AF did not induce nerve injury, showing no significant changes in serum nerve injury biomarkers or heart rate variability post-ablation (all P>.05).
Why the study?
It was unclear whether vagal responses and phrenic activations commonly observed during pulsed field ablation represent nerve damage or a neurological stress response to electrical stimulation.
Does pulsed field ablation induce nerve injury or alter heart rate variability in patients with paroxysmal atrial fibrillation?
Observational (n=18)
Does pulsed field ablation induce nerve injury or alter heart rate variability in patients with paroxysmal atrial fibrillation?
Pulsed field ablation for pulmonary vein isolation in paroxysmal AF does not appear to induce nerve injury or alter autonomic tone, suggesting vagal and phrenic responses during the procedure are likely transient stress responses rather than structural damage.
Answers are grounded in this paper and cite their sources.
Supports PFA nerve safety in paroxysmal AF; hypothesis-generating and requires randomized confirmation.
BackgroundVagal responses and phrenic activation are commonly observed during pulsed field ablation (PFA). However, whether the vagal responses and phrenic activations are nerve damage or a neurological stress response due to electrical stimulation is unclear.ObjectiveThe purpose of this study was to evaluate the effect of a PFA system for performing pulmonary vein isolation on the autonomic nervous system.MethodsPatients with paroxysmal atrial fibrillation (AF) who underwent PFA between August 2021 and November 2021 were included. Nerve injury biomarkers and heart rate variability were obtained preablation and postablation. Patients were scheduled to undergo magnetic resonance imaging and diffusion-weighted imaging to evaluate cerebral microembolus formation postablation.ResultsAcute electrical isolation was achieved in 100% of pulmonary veins (n = 72) in the 18 patients. Mean total procedural time was 64.1 ± 18.2 minutes, and mean fluoroscopy time was 12.3 ± 3.5 minutes. Serum nerve injury biomarkers did not show any changes preablation and immediately postablation and 24 hours after ablation (all P >.05). Preablation and 30-day postablation heart rate variability did not differ (all P >.05). Postablation diffusion-weighted imaging revealed no acute cerebral microembolus events. Moreover, there were no other procedure-related complications. The 8-month Kaplan-Meier estimate of freedom from arrhythmia was 83% ± 9%.ConclusionPFA does not induce nerve injury during pulmonary vein isolation for paroxysmal AF. Vagal responses and phrenic activation are commonly observed during pulsed field ablation (PFA). However, whether the vagal responses and phrenic activations are nerve damage or a neurological stress response due to electrical stimulation is unclear. The purpose of this study was to evaluate the effect of a PFA system for performing pulmonary vein isolation on the autonomic nervous system. Patients with paroxysmal atrial fibrillation (AF) who underwent PFA between August 2021 and November 2021 were included. Nerve injury biomarkers and heart rate variability were obtained preablation and postablation. Patients were scheduled to undergo magnetic resonance imaging and diffusion-weighted imaging to evaluate cerebral microembolus formation postablation. Acute electrical isolation was achieved in 100% of pulmonary veins (n = 72) in the 18 patients. Mean total procedural time was 64.1 ± 18.2 minutes, and mean fluoroscopy time was 12.3 ± 3.5 minutes. Serum nerve injury biomarkers did not show any changes preablation and immediately postablation and 24 hours after ablation (all P >.05). Preablation and 30-day postablation heart rate variability did not differ (all P >.05). Postablation diffusion-weighted imaging revealed no acute cerebral microembolus events. Moreover, there were no other procedure-related complications. The 8-month Kaplan-Meier estimate of freedom from arrhythmia was 83% ± 9%. PFA does not induce nerve injury during pulmonary vein isolation for paroxysmal AF.
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Guo et al. (2022) conducted an observational in Paroxysmal atrial fibrillation (n=18). Pulsed field ablation (PFA) was evaluated on Changes in serum nerve injury biomarkers and heart rate variability (p=>.05). Pulsed field ablation for paroxysmal AF did not induce nerve injury, showing no significant changes in serum nerve injury biomarkers or heart rate variability post-ablation (all P>.05).
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