ReviewJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2025
Vagal AF induction test (VAFIT): a new endpoint for optimizing atrial fibrillation ablation through cardioneuroablation.
Review in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Cardioneuroablation for Reflex Syncope and Functional Bradyarrhythmias: A State-of-the-Art Review.Journal of clinical medicine · 2026Review
- Cardioneuroablation for Functional Atrioventricular Block: Let Physiology Lead the Way.JACC. Case reports · 2026Article
- A functional-anatomic mapping protocol for cardioneuroablation: A mechanistic case series.Heart rhythm O2 · 2026Article
- Article
- Enhanced mapping and targeting of ganglionated plexi using peak frequency analysis in cardioneuroablation: a study in autonomic cardiac disorders.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- High-Power Short Duration or Pulsed Field Ablation: What is the Best Choice for AF Ablation?Arquivos brasileiros de cardiologia · 2025Article
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Authors and funding
8 authors.
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Abstract
introductionCurrently, there is no reliable endpoint for the conclusion of atrial fibrillation (AF) ablation. Atrial burst pacing and/or isoproterenol challenge are poor diagnostic tools. A newly proposed vagal AF induction test (VAFIT) uses effective atrial refractory period measurement, simultaneously with extra-cardiac vagal stimulation (ECVS) to study AF inducibility pre- and post-ablation. This is a prospective study in patients submitted to radiofrequency catheter pulmonary vein isolation (PVI) plus cardioneuroablation (CNA) evaluating the VAFIT result before and at the end of the procedure with AF recurrence.
methodsProspective study of 142 patients, 57.5 (48.9-70.2) years old, 71% males, with symptomatic AF (79.6% paroxysmal/20.4% persistent), left atrium diameter of 38.0 (35.0-41.2) mm, and left ventricular ejection fraction of 63.0 (62.0-68.2). VAFIT was considered positive or negative depending on whether AF induction occurred. It was performed at baseline and after PVI + CNA, with a single atrial extra stimulus during ECVS (5 s/50 Hz/1 V/kg up to 70 V/pulse width = 50 µs). Patients were followed for a median of 15.0 (7.0-20.0) months. The association of VAFIT-positive status at the end of the procedure with AF recurrence was investigated by univariate and multivariate Cox regression analysis.
resultsPre-ablation VAFIT was positive in all cases and became negative in 62.9% of patients. AF recurrence: 18.7% in VAFIT-positive and 5.6% in VAFIT-negative patients (p = 0.012). VAFIT-positivity was associated with AF recurrence (HR 4.56 (1.37-15.23, p = 0.014).
conclusionA VAFIT-positive status following PVI + CNA was strongly and independently associated with AF recurrence. VAFIT negative status reduced 4.5 times the post-ablation AF recurrence. It remains to be investigated in randomized studies whether achieving VAFIT-negativity at the end of the procedure, as demonstrated in this study, would lead to better clinical outcomes.
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