Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Autonomic effects and ablation success after pulsed field and cryoballoon ablation: a SINGLE SHOT CHAMPION substudy.
Trial report in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsPulmonary vein isolation (PVI) using radiofrequency and cryoballoon ablation (CBA) modulates the cardiac autonomic nervous system (ANS) by affecting epicardial ganglionated plexi. In contrast, pulsed field ablation (PFA) appears to exert minimal autonomic effects. The impact of cardiac ANS modulation on arrhythmia recurrence remains incompletely understood. METHODS AND
resultsIn this multicentre trial substudy, 210 patients with symptomatic paroxysmal atrial fibrillation (AF) were randomized 1:1 to PVI using PFA or CBA. All patients received an implantable cardiac monitor at the time of ablation. Daytime heart rate (DHR), night-time heart rate (NHR), and heart rate variability (HRV) were continuously recorded over 12 months and analysed at Days 1-2, Months 3, 6, 9, and 12 post-ablation, and related to arrhythmia-free outcome. PFA (n = 105) was associated with higher HRV at Days 1-2 compared to CBA [n = 105; 100 (79-122) ms vs. 73 (59-93) ms, P < 0.001]. This trend persisted throughout follow-up. DHR and NHR were also consistently lower in the PFA group. Freedom from arrhythmia recurrence at 12 months was higher with PFA than CBA (63% vs. 49%, P = 0.046). HRV did not differ between PFA patients with and without recurrence. A stronger initial HRV suppression predicted favourable outcomes in CBA patients (67 ms vs. 84 ms in patients without vs. with arrhythmia recurrence, P = 0.002).
conclusionDespite reduced cardiac ANS modulation, PFA was associated with a superior arrhythmia-free outcome compared to CBA. These findings suggest that cardiac ANS modulation may not be critical for the successful ablation of paroxysmal AF.
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