PO-04-064 QUANTIFICATION OF AUTONOMIC MODULATION DURING SINGLE-SHOT PULMONARY VEIN ISOLATION WITH PULSED FIELD ABLATION

Abstract

Listen

Translate article

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 been 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. To quantify the degree of parasympathetic denervation during single-shot PVI with PFA compared with CBA. We prospectively included consecutive patients undergoing autonomic modulation assessment with extracardiac vagal stimulation (ECVS) during single-shot PVI for paroxysmal AF with PFA and CBA. Patients with previous ablations were excluded. The response to ECVS was determined as the sinus pause following stimulation, measuring the maximum PP interval (sinus node response). Baseline and post-ablation responses to ECVS were collected and analysed. The degree of autonomic modulation in the two groups was assessed by evaluating the difference between pre- and post-ablation responses to ECVS. A total of 30 patients (PFA group, n=15 vs CBA group, n=15) were included in the analysis. Baseline patients’ characteristics were similar between the two groups (Table 1). 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 with CBA (9897.9 ± 2702.0 ms vs. 874.6 ± 213.6 ms; p<0.001, Figure 1). 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). Single-shot PVI with PFA was associated with less autonomic modulation compared with CBA at ECVS testing. This is likely the result of cardiac tissue selectivity, with minimal effect on the autonomic nervous system. The clinical impact of reduced parasympathetic denervation of PFA on AF outcome is yet to be elucidated.