Sebastian Graeger, Sanjiv M Narayan, Christian Meyer, Dominik Linz, Andreas Rillig, Maura M Zylla, Ramin Ebrahimi, Firat Duru, Laura Perrotta, Kars Neven, Christian-Hendrik Heeger, Martin H Ruwald, Piotr Futyma, Bart A Mulder, Gozal Mirzayeva, Márcio Galindo Kiuchi, Martin Martinek, Helmut Pürerfellner, Serge Boveda, Yuehui Yin, Gang Yang, Hailei Liu, Minglong Chen, Boris Schmidt, Julian K R Chun, Mu Qin, Xumin Hou, Xu Liu, Jingquan Zhong, Shaojie Chen
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This study aimed to compare the autonomic effects of pulsed field ablation (PFA) versus thermal ablation (TA) in patients with atrial fibrillation (AF) through a pooled-analysis.</p><p><strong>Methods: </strong>A systematic search of PubMed and Embase was conducted through April 5, 2025, to identify comparative studies. The primary outcome was increase-in-heart-rate (IHR) after ablation, and the secondary outcome was increase in serum S100B (IS100B), a marker of neural injury.</p><p><strong>Results: </strong>Eight studies involving 1007 AF patients were included (mean age: 63,39 ± 10,75 years; 36.3% female; maximum follow-up: 12 months). Baseline characteristics, including the use of antiarrhythmic drugs, were similar between the PFA and TA groups. Pooled-analysis showed that PFA was associated with a significantly lower IHR compared to TA (PFA: 4.41 ± 8.86 bpm vs. TA: 10.81 ± 10.46 bpm; p < 0.00001). This difference persisted at midterm (3-6 months) and long-term (12 months) follow-up and remained consistent across age, sex, and different TA modalities (cryoballoon vs. radiofrequency). Correspondingly, the IS100B was significantly less pronounced after PFA (PFA: 33.27 ± 9.46 pg/ml vs. TA: 97.53 ± 31.88 pg/ml; p < 0.00001).</p><p><strong>Conclusions: </strong>PFA-based pulmonary-vein-isolation in patients with AF results in a smaller post-procedural IHR and less S100B release, suggesting reduced neural damage and less disruption of the autonomic nervous system compared to TA. These effects are sustained through mid- to long-term follow-up and may have potential implications for patient selection and individualized ablation strategies.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Peri-procedure and Mid-Long Term Effects of Pulsed Field Ablation vs. Thermal Ablation (Cryo- or Radiofrequency) on Autonomic Nervous System Function in Atrial Fibrillation: A Systematic and Quantitative Pooled-Analysis with Potential Implications for Patient Selection (The PULSE-COLD-HEAT-ANS Collaboration).\",\"authors\":\"Sebastian Graeger, Sanjiv M Narayan, Christian Meyer, Dominik Linz, Andreas Rillig, Maura M Zylla, Ramin Ebrahimi, Firat Duru, Laura Perrotta, Kars Neven, Christian-Hendrik Heeger, Martin H Ruwald, Piotr Futyma, Bart A Mulder, Gozal Mirzayeva, Márcio Galindo Kiuchi, Martin Martinek, Helmut Pürerfellner, Serge Boveda, Yuehui Yin, Gang Yang, Hailei Liu, Minglong Chen, Boris Schmidt, Julian K R Chun, Mu Qin, Xumin Hou, Xu Liu, Jingquan Zhong, Shaojie Chen\",\"doi\":\"10.1093/europace/euaf242\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background/aim: </strong>Ablation modalities differ in their mechanisms of action, tissue specificity, and collateral effects-particularly on the cardiac-autonomic-nervous-system. This study aimed to compare the autonomic effects of pulsed field ablation (PFA) versus thermal ablation (TA) in patients with atrial fibrillation (AF) through a pooled-analysis.</p><p><strong>Methods: </strong>A systematic search of PubMed and Embase was conducted through April 5, 2025, to identify comparative studies. The primary outcome was increase-in-heart-rate (IHR) after ablation, and the secondary outcome was increase in serum S100B (IS100B), a marker of neural injury.</p><p><strong>Results: </strong>Eight studies involving 1007 AF patients were included (mean age: 63,39 ± 10,75 years; 36.3% female; maximum follow-up: 12 months). Baseline characteristics, including the use of antiarrhythmic drugs, were similar between the PFA and TA groups. Pooled-analysis showed that PFA was associated with a significantly lower IHR compared to TA (PFA: 4.41 ± 8.86 bpm vs. TA: 10.81 ± 10.46 bpm; p < 0.00001). This difference persisted at midterm (3-6 months) and long-term (12 months) follow-up and remained consistent across age, sex, and different TA modalities (cryoballoon vs. radiofrequency). Correspondingly, the IS100B was significantly less pronounced after PFA (PFA: 33.27 ± 9.46 pg/ml vs. TA: 97.53 ± 31.88 pg/ml; p < 0.00001).</p><p><strong>Conclusions: </strong>PFA-based pulmonary-vein-isolation in patients with AF results in a smaller post-procedural IHR and less S100B release, suggesting reduced neural damage and less disruption of the autonomic nervous system compared to TA. These effects are sustained through mid- to long-term follow-up and may have potential implications for patient selection and individualized ablation strategies.</p>\",\"PeriodicalId\":11981,\"journal\":{\"name\":\"Europace\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.4000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Europace\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/europace/euaf242\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Europace","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/europace/euaf242","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景/目的：消融方式在其作用机制、组织特异性和附带效应方面有所不同，特别是对心脏-自主神经系统。本研究旨在通过汇总分析比较脉冲场消融（PFA）与热消融（TA）对心房颤动（AF）患者的自主神经效应。方法：到2025年4月5日，对PubMed和Embase进行系统检索，以确定比较研究。主要终点是消融后心率（IHR）的增加，次要终点是血清S100B （IS100B）的增加，这是神经损伤的标志。结果：纳入8项研究，共1007例房颤患者（平均年龄：63,39±10.75岁，女性36.3%，最长随访时间：12个月）。基线特征，包括抗心律失常药物的使用，在PFA组和TA组之间相似。合并分析显示，与TA相比，PFA与IHR显著降低相关（PFA: 4.41±8.86 bpm vs. TA: 10.81±10.46 bpm; p < 0.00001）。这种差异在中期（3-6个月）和长期（12个月）随访中持续存在，并在年龄、性别和不同的TA方式（冷冻球囊vs射频）中保持一致。相应的，PFA后IS100B明显减少（PFA: 33.27±9.46 pg/ml vs. TA: 97.53±31.88 pg/ml; p < 0.00001）。结论：与TA相比，基于pfa的房颤患者肺静脉隔离可导致更小的术后IHR和更少的S100B释放，这表明神经损伤和自主神经系统的破坏更少。这些影响在中长期随访中持续存在，可能对患者选择和个体化消融策略有潜在的影响。
Peri-procedure and Mid-Long Term Effects of Pulsed Field Ablation vs. Thermal Ablation (Cryo- or Radiofrequency) on Autonomic Nervous System Function in Atrial Fibrillation: A Systematic and Quantitative Pooled-Analysis with Potential Implications for Patient Selection (The PULSE-COLD-HEAT-ANS Collaboration).
Background/aim: Ablation modalities differ in their mechanisms of action, tissue specificity, and collateral effects-particularly on the cardiac-autonomic-nervous-system. This study aimed to compare the autonomic effects of pulsed field ablation (PFA) versus thermal ablation (TA) in patients with atrial fibrillation (AF) through a pooled-analysis.
Methods: A systematic search of PubMed and Embase was conducted through April 5, 2025, to identify comparative studies. The primary outcome was increase-in-heart-rate (IHR) after ablation, and the secondary outcome was increase in serum S100B (IS100B), a marker of neural injury.
Results: Eight studies involving 1007 AF patients were included (mean age: 63,39 ± 10,75 years; 36.3% female; maximum follow-up: 12 months). Baseline characteristics, including the use of antiarrhythmic drugs, were similar between the PFA and TA groups. Pooled-analysis showed that PFA was associated with a significantly lower IHR compared to TA (PFA: 4.41 ± 8.86 bpm vs. TA: 10.81 ± 10.46 bpm; p < 0.00001). This difference persisted at midterm (3-6 months) and long-term (12 months) follow-up and remained consistent across age, sex, and different TA modalities (cryoballoon vs. radiofrequency). Correspondingly, the IS100B was significantly less pronounced after PFA (PFA: 33.27 ± 9.46 pg/ml vs. TA: 97.53 ± 31.88 pg/ml; p < 0.00001).
Conclusions: PFA-based pulmonary-vein-isolation in patients with AF results in a smaller post-procedural IHR and less S100B release, suggesting reduced neural damage and less disruption of the autonomic nervous system compared to TA. These effects are sustained through mid- to long-term follow-up and may have potential implications for patient selection and individualized ablation strategies.
期刊介绍：
EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.
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