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

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.

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.

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.

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.