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HEART RATE VARIABILITY IN PATIENTS UNDERGOING PULMONARY VEIN ISOLATION USING PULSED FIELD AND RADIOFREQUENCY ENERGY

J. Veselá, D. Heřman, M. Hozman, J. Karch, V. Filipcová, L. Povišer, J. Hozmanová, I. Kolesárová, P. Osmančík (Prague)

Tématický okruh: Poruchy rytmu, kardiostimulace

Typ: Poster - lékařský, CCVRID 2024

Aim
Pulmonary vein isolation (PVI) using radiofrequency (RF) energy, in addition to electrical isolation of the veins, leads to the ablation of collateral ganglion plexuses and thus to the influence of the autonomic nervous system. Data on the effect of pulsed field (PF) ablation are very limited. The aim was to compare heart rate variability (HRV) in patients undergoing PVI using RF and PF energy.

Methodology
Forty-eight patients who underwent PVI were included in the study. 26 patients underwent PVI with PF (PFA) and 22 with RF energy (RFA). All patients had a 24-hour Holter ECG recorded the day before the procedure and 1 month after the procedure. Parameters from the time, frequency, and non-linear domains were analyzed.
Results
The mean age was 58±9 years in the PFA and 64±12 years in the RFA group (p=n.s.). 7 patients in the PFA group and 9 in the RFA did not have an evaluable Holter before the procedure due to a large temporal representation of atrial fibrillation or SVES. Mean heart rate increased after 1 month in both groups, in PFA from 63±9 to 69±10 bpm (p=0.001), in RFA from 56±9 to 67±10 bpm (p=0.0005). Of the frequency parameters, there have been changes in the area of very low frequencies (VLF). Power in the VLF decreased from 178±90 ms2 to 133±91 ms2 (p=0.005) in the PFA group and from 224 ms2 to 55±53 (p=0.002) in the RFA group. Power values in the VLF region at 1-month control were significantly lower in the RF group (69±74) compared to PF patients (123±85, p=0.005). Of the non-linear parameters, the SD2 parameter decreased from 38±14 ms to 32±14 ms (p=0.002) in the PF group and from 41±32 to 23±17 (p=0.048).
Conclusion
When isolating the pulmonary veins, the autonomic system is affected by both RF and PF energy. Changes after radiofrequency ablation are more pronounced than after pulsed field ablation.