SPC365

Acute heart-rate response predicts atrial fibrillation recurrence after cardioneuromodulation and pulmonary vein isolation

Session: Sessão de Comunicações Orais 13 – Para além do isolamento das veias pulmonares: estratégias avançadas na ablação da fibrilhação auricular
Speaker: Tiago Filipe Serrano Constantino

Congress: CPC 2026
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Tiago Serrano Constantino; Filipe Leão; Pedro Silva Cunha, Phd; Bruno Valente; Ana Lousinha, Phd; Paulo Osório; Guilherme Portugal; Madalena Cruz; Helder Santos; Sofia Jacinto; Rui Cruz Ferreira; Mário Oliveira, Phd

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="color:#1f497d">Introduction</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Cardiac neuromodulation (CNM) seeks to rebalance cardiac autonomic tone by targeting atrial ganglionated plexi (GP). While CNM is increasingly used in vagally mediated atrial fibrillation (AF), predictors of arrhythmia recurrence and the durability of autonomic modulated response remain uncertain. Mechanistic and clinical data suggest age-dependent vagal tone and a potential role for immediate heart-rate (HR) shifts in informing about outcomes; however, real-world evidence is limited.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="color:#1f497d">Purpose</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">To identify demographic, clinical and procedural predictors of AF recurrence and to characterize the acute autonomic response after CNM in a single-centre cohort.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="color:#1f497d">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">We conducted a retrospective study of 33 consecutive patients who underwent CNM combined with pulmonary veins isolation (PVI) for paroxysmal AF associated with pronounced baseline bradycardia (<span style="font-family:Symbol">&pound;</span> 50bpm). Comorbidities, medication and symptoms were recorded. HR and heart-rate variability (HRV) indices were assessed pre&nbsp;and post-procedure when available. Primary endpoint was AF recurrence documented by ECG or ambulatory monitoring. Immediate autonomic response was predefined as a stable HR rise &gt;10 bpm, between the last pre-ablation and first post-ablation measurements. Comparisons used t-tests or Fisher&rsquo;s exact test, as appropriate. Missing data were analyzed as observed without imputation.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="color:#1f497d">Results</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Mean age was 59.8 &plusmn; 12.5 years (51.5% male, hypertension - 63.6%, dyslipidaemia - 51.5%, diabetes - 12.1%; regular sport activity - 9.1%). Recurrent palpitations before ablation were present in 87.9%. The mean number of ablated GP procedure was 2.44 &plusmn; 1.22. No major complications occurred. Patients with AF recurrence were younger (52.8 &plusmn; 15.2 vs 61.6 &plusmn; 10.8 years; one-sided p = 0.047, Figure 1B). An immediate HR rise &gt;10 bpm occurred in 22/33 (66.7%) and was associated with a lower AF recurrence rate (27% vs 55%; p = 0.03, Figure 1A). &nbsp;Neither classic atrial stimulation (High-frequency stimulation to GP to assess the autonomic response), extracardiac vagal nerve stimulation nor targeting &ge;3 versus &le;2 GP was associated with recurrence on univariate testing (p &gt; 0.10). Paired comparisons of pre vs post-procedure HR showed no significant shift (mean difference 1.7 bpm; p = 0.62), and HRV changes were heterogeneous owing to limited availability.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="color:#1f497d">Conclusion(s)</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">In this cohort, CNM combined with PVI was a safe procedure, producing immediate sustained HR increase in two-thirds of patients. AF recurrence was associated with younger age and absence of acute HR rise. These findings support incorporating simple intra-procedural markers into decision-making and follow-up planning. Validation in larger, prospective cohorts is warranted to refine candidate selection and optimize CNM durability.</span></span></p>