Backgrounds:   Cardiac-specific energy deliverly represents the pulsed-field ablation (PFA). Although the autonomic reaction such as bradycardia is observed frequently during PFA-guided pulmonary vein isolation (PVI), its effect on the adjasent intrinsic cardiac autonomic nervous system (ICANS) is unclear.

Objective: This study is thought to reveal the clinical impact of PFA on ICANS by investigating the serum S100B increase, a well-known neural injury relevant biomarker concomitant to denervation during PVI.

 Methods:  Pre- and postprocedural serum S100B analysis was conduced in consecutive patients undergoing PVI using either FARAPULSE PFA or cryoballoon (CB) catheter. The S100B increase was analyzed between two technologies. As a secondary subanalysis, cerebral magnetic resonance imaging (MRI) was conducted to investigate its central neural effect through the silent emboli.

Results: A total of 138 patients (PFA: 86 patients and CB: 52 patients) were enrolled. All procedures were completed without any touch-up ablation catheter. The median overall serum S100B increase was (0.05 [0.02-0.123]  μg/l with a lower increase in PFA-PVI (0.02 [0.01-0.05] μg/l) compared to CB-PVI (0.13 [0.09-0.18] μg/l, p<0.0001). MRI was conducted in 77 patients, of which cerebral emboli was detected in 12 (PFA: 10/54 patients (18.5 %) vs. CB: 2/23 patients (8.7 %), p=0.493)). In patients without cerebral emboli, the serum S100B increase was lower in PFA-PVI (0.03 [0.01-0.05] μg/l) compared to CB-PVI (0.12 [0.09-0.2], p<0.0001).