Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025
Comparative spatiotemporal neuromodulation effect between pulsed field and cryoballoon ablation for atrial fibrillation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Nakasone Kazutaka, Tanaka Kaoru, Del Monte Alvise, Della Rocca Domenico Giovanni, Pannone Luigi, Vetta Giampaolo, Overeinder Ingrid, Bala Gezim, Sorgente Antonio, Sieira Juan, Almorad Alexandre, Brugada Pedro, Sarkozy Andrea, Chierchia Gian Battista, de Asmundis Carlo, Ströker Erwin
Аннотация
BACKGROUND: Thermal ablation for atrial fibrillation (AF) exerts a variable additive cardiac neuromodulation effect, primarily via the right anterior ganglionated plexus (RAGP), located between the right superior pulmonary vein (RSPV) and superior vena cava (SVC). The impact of non-thermal pulsed field ablation (PFA) on neuromodulation remains unclear. Our objective was to compare the spatiotemporal neuromodulation effect between thermal and non-thermal AF ablation.
METHODS: Consecutive paroxysmal AF patients undergoing either first-time cryoballoon ablation (CBA) or PFA with pre-procedural cardiac computed tomography (CT) were evaluated. Anatomic CT evaluation included measurement of the shortest distance between RSPV and SVC (RSPV-SVC distance). Changes in heart rate (HR) were assessed via electrocardiograms during and after ablation.
RESULTS: A total of 280 patients (CBA, n = 210; PFA, n = 70) were included, with similar baseline characteristics between both groups. Significant intraprocedural HR increase (ΔHR ≥ 15 bpm) was observed in 116 patients: CBA (n = 88, 42%), PFA (n = 28, 40%), p = 0.779. Although there was no difference in baseline HR between CBA vs PFA groups, HR at the end of the procedure was higher only in CBA group (75 ± 11 bpm vs 66 ± 11 bpm; p < 0.001). Multivariable analysis identified the RSPV-SVC distance (OR 0.607; 95% CI 0.445-0.775; p < 0.001) and younger age (OR 0.950; 95% CI 0.905-0.993; p = 0.030) as independent predictors of an intraprocedural ΔHR ≥ 15 bpm.
CONCLUSION: Both CBA and PFA for AF modulate the RAGP, particularly in patients with a shorter RSPV-SVC distance. However, neuromodulation with PFA is only transient during the procedure.
METHODS: Consecutive paroxysmal AF patients undergoing either first-time cryoballoon ablation (CBA) or PFA with pre-procedural cardiac computed tomography (CT) were evaluated. Anatomic CT evaluation included measurement of the shortest distance between RSPV and SVC (RSPV-SVC distance). Changes in heart rate (HR) were assessed via electrocardiograms during and after ablation.
RESULTS: A total of 280 patients (CBA, n = 210; PFA, n = 70) were included, with similar baseline characteristics between both groups. Significant intraprocedural HR increase (ΔHR ≥ 15 bpm) was observed in 116 patients: CBA (n = 88, 42%), PFA (n = 28, 40%), p = 0.779. Although there was no difference in baseline HR between CBA vs PFA groups, HR at the end of the procedure was higher only in CBA group (75 ± 11 bpm vs 66 ± 11 bpm; p < 0.001). Multivariable analysis identified the RSPV-SVC distance (OR 0.607; 95% CI 0.445-0.775; p < 0.001) and younger age (OR 0.950; 95% CI 0.905-0.993; p = 0.030) as independent predictors of an intraprocedural ΔHR ≥ 15 bpm.
CONCLUSION: Both CBA and PFA for AF modulate the RAGP, particularly in patients with a shorter RSPV-SVC distance. However, neuromodulation with PFA is only transient during the procedure.