Abstract

Background
Additional ganglionated plexi (GPs) ablation beyond pulmonary vein isolation (PVI) has been associated with better outcomes after radiofrequency ablation. Because of the anatomical relationship between the major atrial GPs and the pulmonary veins, single-shot PVI with cryoballoon catheter ablation (CBA) has demonstrated to concomitantly affect the GPs, as documented by intraprocedural vagal reactions and increased heart rates (HR) after ablation. The novel multispline pulsed field ablation catheter (PFA) is emerging as a safe and effective non- thermal single-shot alternative for PVI, with ablation selectivity for the cardiac tissue.
Objective
To quantify the degree of parasympathetic denervation during single-shot PVI with PFA compared with CBA.
Methods
• We prospectively included consecutive patients undergoing autonomic modulation assessment with extracardiac vagal stimulation (ECVS) during single-shot PVI with PFA and CBA for paroxysmal atrial fibrillation (AF).
• Patients with previous ablations were excluded.
• The response to ECVS was determined as the maximum PP
interval (sinus node response) following vagal stimulation.
• Baseline and post-ablation responses to ECVS were collected. The degree of autonomic modulation in the two groups was assessed by evaluating the difference between
pre- and post-ablation responses to ECVS.
Results
• 30 patients (PFA n=15 vs CBA n=15) were included. Baseline patients’ characteristics were similar between the two groups.
• Pre-ablation responses to ECVS were similar between the
PFA and CBA groups (10757.3±3155.2 ms vs. 11155.9±2472.3 ms, p=0.70).
• Vagal reactions during PVI occurred more frequently with PFA than CBA (86.7% vs 20%, p=0.001), more commonly during left superior PVI.
• After PVI, the sinus pause following ECVS was significantly longer after PFA compared to CBA (9897.9±2702.0 ms vs. 874.6±213.6 ms; p<0.001).
• Despite similar baseline values, 24h post-ablation HR increased significantly more with CBA than PFA (14.0±6.8 bpm vs. 1.8±8.4 bpm, respectively; p<0.001).
Conclusions
• Single-shot PVI with PFA was associated with less autonomic modulation compared to CBA at ECVS testing.
• A reduced neuromodulation with PFA is likely the result of its cardiac tissue selectivity, with minimal effect on the cardiac autonomic nervous system.
• The clinical impact of reduced parasympathetic denervation with PFA on AF outcome is yet to be elucidated.
Original languageEnglish
Publication statusUnpublished - 2023
EventHRS 2023 - New Orleans, New Orleans, United States
Duration: 19 May 202321 May 2023

Conference

ConferenceHRS 2023
Country/TerritoryUnited States
CityNew Orleans
Period19/05/2321/05/23

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