{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:37:37Z","timestamp":1791520657824,"version":"4.3.4"},"reference-count":15,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pulmonary vein isolation (PVI) with thermal energy is characterized by concomitant ablation of the surrounding ganglionated plexi (GP). Pulsed\u2010field ablation (PFA) selectively targets the myocardium and seems associated with only negligible effects on the autonomic nervous system (ANS). However, little is known about the dynamic effects of PFA on the GP immediately after PVI. This study sought to investigate the degree and acute vagal modulation induced by the Farapulse<jats:sup>TM<\/jats:sup> PFA system during PVI compared with single\u2010shot thermal ablation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 76 patients underwent first\u2010time PVI with either Farapulse<jats:sup>TM<\/jats:sup> PFA (PFA group, <jats:italic>n<\/jats:italic>\u2009=\u200940) or cryoballoon ablation (thermal ablation group, <jats:italic>n<\/jats:italic>\u2009=\u200936) for paroxysmal atrial fibrillation (AF). The effect on the ANS in the two groups was assessed before and after PVI with extracardiac vagal stimulation (ECVS). To capture any transient effects of PFA on the ANS, in a subgroup of PFA patients ECVS was repeated at three predefined timepoints: (1) before PVI (T0); (2) immediately after PVI (T1); and (3) 10\u2009min after the last energy application (T2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Despite similar baseline values, the vagal response induced by ECVS after PVI almost disappeared in the thermal ablation group but persisted in the PFA group (thermal group: 840 [706\u20131090]\u2009ms, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001 compared to baseline; PFA group: 11\u2009466 [8720\u201312\u2009293]\u2009ms, <jats:italic>p<\/jats:italic>\u2009=\u2009.70 compared to baseline). Intraprocedural vagal reactions (defined as RR increase &gt;50%, transitory asystole, or atrioventricular block) occurred more frequently with PFA than thermal ablation (70% vs. 28%, <jats:italic>p<\/jats:italic>\u2009=\u2009.001). Moreover, heart rate 24\u2009h post\u2010PVI increased more with thermal ablation than with PFA (16.5\u2009\u00b1\u20099.0 vs. 2.6\u2009\u00b1\u20096.1\u2009beats\/min, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). In the subgroup of PFA patients undergoing repeated ANS modulation assessment (<jats:italic>n<\/jats:italic>\u2009=\u200911), ECVS demonstrated that PFA determined a significant acute suppression of the vagal response immediately after PVI (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001 compared to baseline), which recovered almost completely within 10\u2009min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PVI with the Farapulse<jats:sup>TM<\/jats:sup> PFA system is associated with only transitory and short\u2010lasting vagal effects on the ANS which recover almost completely within a few minutes after ablation. The impact of this phenomenon on AF outcome needs to be further investigated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16089","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T16:50:16Z","timestamp":1696438216000},"page":"2393-2397","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Quantitative assessment of transient autonomic modulation after single\u2010shot pulmonary vein isolation with pulsed\u2010field ablation"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6672-4931","authenticated-orcid":false,"given":"Alvise","family":"Del Monte","sequence":"first","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Cesp\u00f3n Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1120-0492","authenticated-orcid":false,"given":"Giampaolo","family":"Vetta","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico Giovanni","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9769-1511","authenticated-orcid":false,"given":"Luigi","family":"Pannone","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Mouram","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Sorgente","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gezim","family":"Bala","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwin","family":"Str\u00f6ker","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Sieira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Almorad","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard\u2010Heart Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Sarkozy","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Cardiac 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