{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T02:40:25Z","timestamp":1778812825975,"version":"3.51.4"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Catheter ablation is an established therapy for atrial fibrillation (AF), with thermal ablation as a standard modality. Pulsed\u2010field ablation (PFA) is a nonthermal alternative that selectively ablates myocardium while sparing collateral tissue. Its comparative autonomic impact relative to thermal ablation remains unclear. The study aims to compare autonomic changes following PFA and thermal ablation in AF patients, focusing on heart rate (HR), heart rate variability (HRV), bradyarrhythmias, and arrhythmia recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched MEDLINE, EMBASE, and Cochrane CENTRAL through August 2025 for randomized and nonrandomized studies reporting pre\u2010 and post\u2010ablation HR or HRV. Data were pooled using random\u2010effects or fixed\u2010effects models, depending on the presence of heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six studies (800 patients, PFA: 407, thermal: 393) were included. Thermal ablation was associated with a significantly greater rise in resting HR compared with PFA (mean difference \u20107.57\u00a0bpm, 95%CI: \u201011.66\u20103.48, p = 0.0003; I\n                      <jats:sup>2<\/jats:sup>\n                      = 90% indicating high heterogeneity). HRV indices were consistently better preserved after PFA. SDNN at 12 months was approximately 150\u00a0ms with PFA versus 115\u00a0ms with thermal ablation (p&lt;0.001 in one study). The overall incidence of bradyarrhythmias did not differ significantly, though transient intraprocedural bradycardia was more frequently observed with PFA. Arrhythmia recurrence rates were comparable between groups (OR 0.96, 95% CI 0.47\u20101.99, p = 0.92; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Acute pulmonary vein isolation was achieved in &gt;95% of patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PFA attenuates autonomic perturbation relative to thermal ablation, preserving resting HR and HRV while maintaining comparable arrhythmia outcomes. These findings support PFA as an effective and autonomically sparing strategy for AF ablation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70126","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T18:08:57Z","timestamp":1768846137000},"page":"296-307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Autonomic Profile Changes After Pulsed\u2010Field Versus Thermal Ablation in Patients With Atrial Fibrillation: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-7476","authenticated-orcid":false,"given":"Ibrahim","family":"Antoun","sequence":"first","affiliation":[{"name":"Department of Cardiology University Hospitals of Leicester NHS Trust, Glenfield Hospital  Leicester UK"},{"name":"Department of Cardiovascular Sciences, Clinical Science Wing University of Leicester, Glenfield Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Elmewafy","sequence":"additional","affiliation":[{"name":"School of Medicine University of Sheffield  Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyad","family":"Jamileh","sequence":"additional","affiliation":[{"name":"Department of Medicine East Lancashire Hospitals NHS Trust  Blackburn UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Abdelrazik","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospitals of Leicester NHS Trust, Glenfield Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0317-1428","authenticated-orcid":false,"given":"Mahmoud","family":"Eldesouky","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospitals of Leicester NHS Trust, Glenfield Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaung Myat","family":"Thu","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospitals of Leicester NHS Trust, Glenfield Hospital  Leicester UK"},{"name":"Department of Cardiovascular Sciences, Clinical Science Wing University of Leicester, Glenfield Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mokhtar","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospitals of Leicester NHS Trust, Glenfield Hospital  Leicester UK"},{"name":"Department of Cardiovascular Sciences, Clinical Science Wing University of Leicester, Glenfield Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riyaz","family":"Somani","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospitals of Leicester NHS Trust, Glenfield Hospital  Leicester UK"},{"name":"Department of Cardiovascular Sciences, Clinical Science Wing University of Leicester, Glenfield Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. Andr\u00e9","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospitals of Leicester NHS Trust, Glenfield Hospital  Leicester UK"},{"name":"Department of Cardiovascular Sciences, Clinical Science Wing University of Leicester, Glenfield Hospital  Leicester UK"},{"name":"National Institute for Health Research Leicester Research Biomedical Centre  Leicester UK"},{"name":"Leicester British Heart Foundation Centre of Research Excellence Glenfield Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_2_12_2_1","article-title":"Atrial Fibrillation Inpatient Management Patterns and Clinical Outcomes during the Conflict in Syria: An Observational Cohort Study","author":"Antoun 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