Vagal Response and Cough Reflex During Atrial Fibrillation Ablation Under Deep Sedation: A Comparison Across…

Abstract

Background

Pulsed field ablation (PFA) is increasingly used for atrial fibrillation (AF), but device-specific autonomic and respiratory reflex responses remain insufficiently characterized. We aimed to compare vagal responses and cough reflexes among three commercially available PFA systems across individual pulmonary veins and the posterior wall.Methods

This retrospective single-center study included 200 consecutive patients who underwent AF ablation with FARAPULSE (n = 83), PULSESELECT (n = 83), or VARIPULSE (n = 34). Vagal response was operationally defined as bradyarrhythmia requiring temporary back-up pacing during energy delivery. Cough reflex was assessed intraprocedurally at the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), and posterior wall.Results

Baseline characteristics were generally similar among groups, although heart failure and diabetes mellitus (DM) differed significantly. Overall vagal response rates did not differ among FARAPULSE, PULSESELECT, and VARIPULSE (61.4%, 67.5%, and 58.8%, respectively; p = 0.596). In contrast, overall cough reflex rates differed significantly (75.9%, 91.6%, and 55.9%; p < 0.001), driven by consistently higher rates with PULSESELECT. On logistic regression, male sex, body mass index, and use of PULSESELECT versus FARAPULSE were independently associated with cough reflex.Conclusions

Cough reflex was most frequent with PULSESELECT, whereas no significant difference in vagal response was observed among platforms. Recognizing these differences may improve procedural planning, sedation strategy, and prophylactic management during PFA.

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BibTeX RIS

BibTeX

@article{saito2026vagal,
  title = {{Vagal Response and Cough Reflex During Atrial Fibrillation Ablation Under Deep Sedation: A Comparison Across Pulsed Field Ablation Systems.}},
  author = {Jumpei Saito and Kenji Kuroki and Takeaki Goto and Chisa Asahina and Koji Sudo and Akira Sato},
  journal = {Journal of arrhythmia},
  year = {2026},
  month = oct,
  doi = {10.1002/joa3.70503},
  url = {https://europepmc.org/article/MED/42923446},
  note = {CC BY-NC},
}

RIS

TY  - JOUR
TI  - Vagal Response and Cough Reflex During Atrial Fibrillation Ablation Under Deep Sedation: A Comparison Across Pulsed Field Ablation Systems.
AU  - Jumpei Saito
AU  - Kenji Kuroki
AU  - Takeaki Goto
AU  - Chisa Asahina
AU  - Koji Sudo
AU  - Akira Sato
PY  - 2026
DA  - 2026/10/21
JO  - Journal of arrhythmia
DO  - 10.1002/joa3.70503
UR  - https://europepmc.org/article/MED/42923446
AB  - Background  Pulsed field ablation (PFA) is increasingly used for atrial fibrillation (AF), but device-specific autonomic and respiratory reflex responses remain insufficiently characterized. We aimed to compare vagal responses and cough reflexes among three commercially available PFA systems across individual pulmonary veins and the posterior wall.Methods  This retrospective single-center study included 200 consecutive patients who underwent AF ablation with FARAPULSE (n = 83), PULSESELECT (n = 83), or VARIPULSE (n = 34). Vagal response was operationally defined as bradyarrhythmia requiring temporary back-up pacing during energy delivery. Cough reflex was assessed intraprocedurally at the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), and posterior wall.Results  Baseline characteristics were generally similar among groups, although heart failure and diabetes mellitus (DM) differed significantly. Overall vagal response rates did not differ among FARAPULSE, PULSESELECT, and VARIPULSE (61.4%, 67.5%, and 58.8%, respectively; p = 0.596). In contrast, overall cough reflex rates differed significantly (75.9%, 91.6%, and 55.9%; p < 0.001), driven by consistently higher rates with PULSESELECT. On logistic regression, male sex, body mass index, and use of PULSESELECT versus FARAPULSE were independently associated with cough reflex.Conclusions  Cough reflex was most frequent with PULSESELECT, whereas no significant difference in vagal response was observed among platforms. Recognizing these differences may improve procedural planning, sedation strategy, and prophylactic management during PFA.
SN  - 1880-4276
SN  - 1883-2148
ER  -

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