Does pulsed-field ablation improve heart rate variability parameters and reduce AF recurrence compared to cryoballoon and radiofrequency ablation in patients with atrial fibrillation?
Pulsed-field ablation demonstrates a milder impact on cardiac autonomic function and is associated with lower AF recurrence rates compared to cryoballoon and radiofrequency ablation at three months.
• PFA has a milder impact on cardiac autonomic function, showing less reduction in HRV parameters compared to CRYO and RF ablation in three months. • PFA is associated with a lower AF recurrence rate, indicating superior therapeutic efficacy. • Understanding the differential impacts on autonomic function can guide personalized treatment choices, optimizing patient-specific therapeutic approaches. • The higher efficacy of PFA in preventing AF recurrence supports its use as a primary ablation strategy. Atrial fibrillation (AF) is a prevalent cardiac arrhythmia. Pulmonary vein isolation (PVI) is a cornerstone for catheter ablation for AF. Most recently, pulsed-field ablation (PFA) has emerged as a novel technique that minimizes tissue damage due to its tissue selectivity with promising clinical success. Despite its promise, the impact of PFA on cardiac autonomic function following PVI, particularly heart rate variability (HRV), and the differences between catheter ablation (CA) techniques, remain unclear. Following PRISMA guidelines, we conducted a systematic review and meta -analysis to evaluate changes in HRV parameters in three months post-catheter ablation using PFA, cryoballoon (CRYO), and radiofrequency (RF) ablation techniques. We searched databases including PubMed, Embase, Scopus, and Web of Science for relevant studies, focusing on HRV metrics such as SDNN, LF and HF in AF patients undergoing CA. Our meta -analysis included 35 studies involving 6,267 AF patients. The results demonstrated a significant increase in heart rate and a decrease in HRV parameters such as SDNN and LF following CA in three months. Subgroup analyses revealed variations across ablation techniques, with PFA showing a milder impact on autonomic function compared to CRYO and RF. Notably, PFA was associated with a lower AF recurrence rate, suggesting superior therapeutic efficacy. PFA demonstrates a lower effect on cardiac autonomic function than the other two ablation techniques in three months. Notably, PFA showed a trend toward superior treatment outcomes, which may inform future choices of ablation technique for PVI in AF management. Further research is warranted to explore long-term autonomic effects and optimize treatment protocols.
Wang et al. (Wed,) studied this question.
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