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Effects of Pulsed Field Ablation on Autonomic Nervous System in Paroxysmal Atrial Fibrillation: A Pilot Study

  • Author Footnotes
    † These authors contributed equally to this work.
    Fuding Guo
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Author Footnotes
    † These authors contributed equally to this work.
    Jun Wang
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Author Footnotes
    † These authors contributed equally to this work.
    Qiang Deng
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Author Footnotes
    † These authors contributed equally to this work.
    Hui Feng
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Information Center; Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Mengjie Xie
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Zhen Zhou
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Liping Zhou
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Yueyi Wang
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Xujun Li
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Saiting Xu
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Shoupeng Duan
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Ji Sun
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Hong Jiang
    Correspondence
    Co-correspondence: Hong Jiang, MD, PhD, FACC, Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province 430060, P.R. China,
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Lilei Yu
    Correspondence
    Correspondence: Lilei Yu, MD, PhD, FACC, Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan City, Hubei Province 430060, P.R. China,
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan 430060, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan 430060, P.R. China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan 430060, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan 430060, P.R. China
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  • Author Footnotes
    † These authors contributed equally to this work.
Published:November 23, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.11.013

      Abstract

      Background

      Vagal responses and phrenic activation are commonly observed during pulsed field ablation (PFA). However, it is unclear whether the vagal responses and phrenic activations are nerve damage or a neurological stress response due to electrical stimulation.

      Objective

      The purpose of this study was to evaluate the effect of a PFA system for performing pulmonary vein isolation on the autonomic nervous system.

      Methods

      Patients with paroxysmal atrial fibrillation (AF) who underwent the PFA between August 2021 and November 2021 were included. Nerve injury biomarkers and heart rate variability were obtained pre- and postablation. Patients were scheduled to undergo magnetic resonance imaging and diffusion-weighted imaging to evaluate cerebral microembolus formation postablation.

      Results

      Acute electrical isolation was achieved in 100% of pulmonary veins (n = 72) in the 18 patients. The mean total procedure time was 64.1 ± 18.2 min, with a mean fluoroscopy time of 12.3 ± 3.5 min. Serum nerve injury biomarkers did not show any changes among the pre- and immediately postablation and 24h after ablation (all P>0.05). Pre- and 30 days postablation heart rate variability did not differ (all P>0.05). Postablation diffusion-weighted imaging revealed no acute cerebral microembolus events. Moreover, there were no other procedure-related complications. The 8-month Kaplan-Meier estimate of freedom from arrhythmia was 83 ± 9%.

      Conclusions

      PFA does not induce nerve injury during pulmonary vein isolation for paroxysmal AF.

      Keywords

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