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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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CLEAR FILTERS
Autonomic Effects of Cryoablation, Radiofrequency, and Pulsed Field Ablation in Atrial Fibrillation
Session:
Sessão de Posters 54 - Da energia aos endpoints na FA
Speaker:
Mariana Caetano Coelho
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Mariana Caetano Coelho; Sérgio Laranjo; Pedro Silva Cunha; Helena Fonseca; Mário Martins Oliveira
Abstract
<p>Introduction: Catheter ablation for pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). Different energy sources—thermal such as cryoablation (CRYO) and radiofrequency (RF), and non-thermal such as pulsed field ablation (PFA)—may have distinct impacts on the cardiac autonomic nervous system (ANS), a factor with potential prognostic implications. This study aimed to compare the effects of PFA, CRYO, and RF on autonomic function and its temporal evolution.</p> <p>Methods: We conducted a prospective observational study in 89 patients with predominantly paroxysmal AF undergoing PVI with either pulsed field ablation (PFA; n=11), cryoablation (CRYO; n=45), or radiofrequency (RF; n=33). The combined cohort had a mean age of 59 ± 10 years and was predominantly male (64%). Autonomic function was assessed through heart rate variability (HRV) analysis in time and frequency domains during a tilt table test protocol. Assessments were performed at baseline (pre-ablation) and at 1, 3, and 6 months of follow-up.</p> <p>Results: The PFA group demonstrated minimal changes in HRV parameters (ΔHR, ΔSDNN, ΔRMSSD ≈ 0), suggesting preservation of autonomic function. In contrast, groups undergoing thermal ablation (CRYO and RF) showed a significant increase in heart rate and a marked reduction in global HRV indices (SDNN) and parasympathetic markers (RMSSD, PHF) (p<0.01), indicating substantial autonomic denervation. Longitudinal analysis revealed partial recovery of chronotropic response and a progressive increase in low-frequency power at 3 and 6 months in the thermal ablation groups, suggestive of adaptive autonomic remodelling and reinnervation over time.</p> <p>Conclusion: Pulsed field ablation demonstrates a superior autonomic safety profile, preserving intrinsic cardiac function compared to thermal energy sources (CRYO and RF), which induce significant denervation. The distinct temporal evolution of autonomic modulation amongst technologies underscores the importance of long-term monitoring and may have implications for ablation strategy selection and arrhythmia recurrence risk stratification.</p>
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