Changes in heart rate variability parameters following pulsed-field ablation in patients with atrial fibrillation: A systematic review and meta-analysis HRV changes after pulsed-field ablation in AF

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-08-13 DOI:10.1016/j.ijcha.2025.101766

Xinyi Wang , Zhicheng Hu , Yan Yao , Pakezhati Maimaitijiang, Aiyue Chen, Lihui Zheng

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引用次数: 0

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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心房颤动患者脉冲场消融后心率变异性参数的变化：AF脉冲场消融后HRV变化的系统回顾和荟萃分析

心房颤动（AF）是一种常见的心律失常。肺静脉隔离（PVI）是房颤导管消融的基础。最近，脉冲场消融（PFA）作为一种新技术出现，由于其组织选择性，最大限度地减少了组织损伤，具有良好的临床成功前景。尽管前景看好，但PFA对PVI后心脏自主功能的影响，特别是心率变异性（HRV），以及导管消融（CA）技术之间的差异仍不清楚。方法：遵循PRISMA指南，我们进行了系统回顾和荟萃分析，以评估PFA、冷冻球囊（CRYO）和射频（RF）消融技术在导管消融后3个月HRV参数的变化。我们检索了PubMed、Embase、Scopus和Web of Science等数据库的相关研究，重点关注房颤患者行ca的HRV指标，如SDNN、LF和HF。结果我们的meta分析包括35项研究，涉及6267例房颤患者。结果显示，CA后3个月内心率显著增加，HRV参数（如SDNN和LF）显著降低。亚组分析揭示了消融技术之间的差异，与CRYO和RF相比，PFA对自主神经功能的影响较轻。值得注意的是，PFA与较低的房颤复发率相关，表明其具有较好的治疗效果。结论pfa在3个月内对心脏自主功能的影响低于其他两种消融术。值得注意的是，PFA显示出更好的治疗结果，这可能为房颤治疗中PVI消融技术的未来选择提供信息。需要进一步的研究来探索长期的自主作用和优化治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.