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Background <p>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.</p> Methods <p>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.</p> Results <p>A total of 280 patients (CBA,&#xa0;<i>n</i> = 210; PFA,&#xa0;<i>n</i> = 70) were included, with similar baseline characteristics between both groups. Significant intraprocedural HR increase (ΔHR ≥ 15&#xa0;bpm) was observed in 116 patients: CBA (<i>n</i> = 88, 42%), PFA (<i>n</i> = 28, 40%), <i>p</i> = 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&#xa0;bpm vs 66 ± 11&#xa0;bpm; <i>p</i> &lt; 0.001). Multivariable analysis identified the RSPV–SVC distance (OR 0.607; 95% CI 0.445–0.775; <i>p</i> &lt; 0.001) and younger age (OR 0.950; 95% CI 0.905–0.993; <i>p</i> = 0.030) as independent predictors of an intraprocedural ΔHR ≥ 15&#xa0;bpm.</p> Conclusion <p>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.</p> Graphical abstract <p>Comparative spatiotemporal neuromodulation between thermal and non-thermal atrial fibrillation ablation. The left upper panel shows the location of the right anterior ganglionated plexus (RAGP) relative to the left atrium. The middle and right upper panels show axial computed tomography images placed at the level of the right superior pulmonary vein (RSPV) and superior vena cava (SVC) with visualization of the RAGP. Together with the rest of the figure, this illustrates the RSPV-SVC distance as independent anatomic variable found for significant intraprocedural (i.e., after RSPV application) heart rate (HR) increase, both for cryoballon ablation (CBA) as pulsed field ablation (PFA). Although more persistent also after the procedure for CBA, this neuromodulation effect is only transiently present in the case of PFA</p> <p></p>

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Comparative spatiotemporal neuromodulation effect between pulsed field and cryoballoon ablation for atrial fibrillation

  • 期刊论文

  • 发表日期：

    2025年12月8日

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  • Kazutaka Nakasone,
  • Kaoru Tanaka,
  • Alvise Del Monte,
  • Domenico Giovanni Della Rocca,
  • Luigi Pannone,
  • Giampaolo Vetta,
  • Ingrid Overeinder,
  • Gezim Bala,
  • Antonio Sorgente,
  • Juan Sieira,
  • Alexandre Almorad,
  • Pedro Brugada,
  • Andrea Sarkozy,
  • Gian Battista Chierchia,
  • Carlo de Asmundis,
  • Erwin Ströker

摘要

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.

Graphical abstract

Comparative spatiotemporal neuromodulation between thermal and non-thermal atrial fibrillation ablation. The left upper panel shows the location of the right anterior ganglionated plexus (RAGP) relative to the left atrium. The middle and right upper panels show axial computed tomography images placed at the level of the right superior pulmonary vein (RSPV) and superior vena cava (SVC) with visualization of the RAGP. Together with the rest of the figure, this illustrates the RSPV-SVC distance as independent anatomic variable found for significant intraprocedural (i.e., after RSPV application) heart rate (HR) increase, both for cryoballon ablation (CBA) as pulsed field ablation (PFA). Although more persistent also after the procedure for CBA, this neuromodulation effect is only transiently present in the case of PFA