Pulsed Field Ablation better for Autonomic Nervous System?

One of the things that has freaked me out about getting a thermal ablation (besides risks like Atrio-Esophageal Fistula) is the supposed drop in heart rate variability after the ablation. Supposedly it recovers in 3-6 months, but this article seems to suggest possible permanent impact on autonomic inervation. And given low heart rate variability is a predictor of developing afib in the first place, it seems counterintuitive that a procedure that drops heart rate variability is optimal. Pulsed field ablation doesn't seem to suffer from this. Anyone here have any thoughts on this matter?

Quote
SamIAm
One of the things that has freaked me out about getting a thermal ablation (besides risks like Atrio-Esophageal Fistula) is the supposed drop in heart rate variability after the ablation. Supposedly it recovers in 3-6 months, but this article seems to suggest possible permanent impact on autonomic inervation. And given low heart rate variability is a predictor of developing afib in the first place, it seems counterintuitive that a procedure that drops heart rate variability is optimal. Pulsed field ablation doesn't seem to suffer from this. Anyone here have any thoughts on this matter?

I did research this before my recent RF ablation as I had had Dysautonomia for many years and was hoping that the ablation (which involved the cardiac autonomic ganglia) might improve my Dysautonomia. I discovered from research that it was looking like the changes to ANS function after an RF ablation were more durable than with a PFA, though they didn’t have long term data. I have tracked my HRV and there has been a modest trend upward since my Nov 2022 ablation. And my Dysautonomia has improved markedly so I am pleased on both fronts.

That's awesome. This is what I had read elsewhere, that HRV recovers. It's just a bit concerning when the article says "cannot be interpreted as restoration of left atrial autonomic innervation back to the preablation baseline". I'll have to try to get the full paper... So far what I've read is that PFA doesn't affect HRV at all, so at least in that respect it seems possibly preferable. I do wonder what possible disadvantages PFA has, aside from risks associated with a newer technology. Perhaps sending a whole lot of electrical energy to the heart could affect the electrical system in some yet to be known way... It's almost one of those things that seems too good to be true.

Maybe one disadvantage could be that current PFA tools might not be very versatile, where they are just used for PVI, but not for flutter or other troublesome spots.... Does anyone know if PFA would be used to treat frequent PACs?

Thanks for the reply.



Edited 2 time(s). Last edit at 06/17/2023 01:12PM by SamIAm.

Quote
SamIAm
Maybe one disadvantage is that current PFA tools aren't very versatile, where they are just used for PVI, but not for flutter or other troublesome spots....

That may be just in some of the trials. See this post: [www.afibbers.org] "I had a PFA last year with Dr Natale in Austin; he ablated the pulmonary veins as well as the posterior wall. PVI + posterior wall is his standard procedure. This was the AdMIRE trial."

I hadn't seen that thread, thanks, I wonder if the posterior wall was done with PFA. I did see another thread where flutter was dealt with separately with RF in same procedure as PFA for PVI. ... I'm in an odd situation where I rarely go into afib/flutter but just have lots of runs of PACs, not sure if PFA would be used for that...

Quote
SamIAm
That's awesome. This is what I had read elsewhere, that HRV recovers. It's just a bit concerning when the article says "cannot be interpreted as restoration of left atrial autonomic innervation back to the preablation baseline".

In my case, my HRV was slightly higher right after the RF ablation and slowly increased in the months after—it is now about 5 points higher than pre-ablation. The ANS aspect that did change and hasn’t gone back to pre-ablation levels is my ability to stand upright without fainting. I used to have 5 -15 minutes before my systolic BP would drop to the point where I had to sit down pronto or faint. After the ablation and continuing now, about 8 months later, I almost never start to faint when standing—perhaps I can stand for as much as an hour? Not pushing it, but it is a huge plus for me. I suspect that ablating those autonomic ganglia increased sympathetic function as testing earlier had shown that I was overbalanced toward the parasympathetic system.



Edited 1 time(s). Last edit at 06/17/2023 02:40PM by Daisy.