Cryoballoon pulmonary vein isolation-mediated rise of sinus rate in patients with paroxysmal atrial fibrillation

Wagner, L. S.; Darche, Fabrice F.; Thomas, Dierk; Lugenbiel, Patrick; Xynogalos, Panagiotis; Seide, Svenja; Scholz, Eberhard; Katus, Hugo A.; Schweizer, Patrick

doi:10.1007/s00392-020-01659-0

Cited by 5 publications

(4 citation statements)

References 45 publications

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“…Our study confirms the significant impact of PVI on cardiac autonomic function with a mean heart rate increase by over 10 bpm at POST which is in line with previously published results [ 5 , 7 – 9 ]. This effect is suggested to be induced by parasympathetic denervation owing to PVI ablation [ 6 , 7 ] which is known to influence the sinus rate, the atrial refractory period and atrioventricular conduction [ 14 ].…”

Section: Discussionsupporting

confidence: 93%

“…The autonomic nervous system has been shown to play a pivotal role in the pathogenesis of atrial fibrillation [ 3 ]. In this regard, it has been shown that patients with atrial fibrillation and a low resting sinus heart rate prior to ablation seem to carry a higher risk for recurrence of atrial fibrillation post-ablation [ 4 , 5 ]. It has been suggested that catheter ablation has an attenuating effect on parasympathetic activity [ 6 , 7 ] leading to an increased resting heart rate post-ablation.…”

Section: Introductionmentioning

confidence: 99%

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Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences

et al. 2020

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Purpose Cather ablation is known to influence the autonomic nervous system. This study sought to investigate the association of sinus heart rate pre-/post-ablation and recurrences in patients with atrial fibrillation undergoing pulmonary vein isolation (PVI). Methods Between January 2012 and December 2017, data of 482 patients undergoing their first PVI were included. Sinus heart rate was recorded before (PRE), directly post-ablation (POST) and 3 months post-ablation (3 M). All patients were screened for atrial tachyarrhythmia recurrences during the one-year follow-up. Results In the total study cohort, the mean resting sinus heart rate at PRE [mean 57.9 bpm (95% CI 57.1–58.7 bpm)] increased by over 10 bpm to POST [mean 69.4 bpm (95% CI 68.5–70.3 bpm); p < 0.001] followed by a slight decrease at 3 M [mean 67.3 bpm (95% CI 66.4–68.2 bpm)] but still remaining higher compared to PRE (p < 0.001). This pattern was observed in patients with and without recurrences at POST and 3 M (both p < 0.001 compared to PRE). However, at 3 M the mean sinus heart rate was significantly lower in patients with compared to patients without recurrences (p = 0.031). In this regard, patients with a heart rate change < 11 bpm (PRE to 3 M) or, as an alternative parameter, patients with a heart rate < 60 bpm at 3 M had a significantly higher risk of recurrences compared to the remaining patients (Hazard ratio (HR) 1.82 (95% CI 1.32–2.49), p < 0.001 and HR 1.64 (95% CI 1.20–2.25), p = 0.002, respectively). Conclusion Our study confirms the impact of PVI on cardiac autonomic function with a significant sinus heart rate increase post-ablation. Patients with a sinus heart rate change < 11 bpm (PRE to 3 M) are at higher risk for recurrences during one-year post-PVI.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences

et al. 2020

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“…Additionally, AF has been associated with bradycardia and need for PPM implantation. 43 , 44 , 45 Especially in patients with sinus node dysfunction, successful treatment of AF and restoration of sinus rhythm may manifest in severe bradycardia requiring PPM implantation. 4 , 24 In our study, we also found a significantly higher percentage of 1 year PPM implantation after HTX in patients with AF before and ≤ 30 days after HTX (5.5%) as well as in patients without AF before HTX but with AF ≤ 30 days after HTX (6.7%) indicating an association between post‐transplant AF and the need for PPM implantation after HTX.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation before heart transplantation is a risk factor for post‐transplant atrial fibrillation and mortality

et al. 2021

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Aims Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX. Methods and resultsThis study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF. Conclusions Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.

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“…Although this is a single case, together with the earlier case report, 13 , 14 it suggests that ablation, rather than permanent pacing, may be a better choice for the initial treatment of asymptomatic, slow AF with SAND and AVND. 15 Table 2 lists the advantages and disadvantages of ablation vs pacing in patients with AF and AVND.…”

Section: Discussionmentioning

confidence: 99%

Cryoballoon pulmonary vein isolation-mediated rise of sinus rate in patients with paroxysmal atrial fibrillation

Cited by 5 publications

References 45 publications

Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences

Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences

Atrial fibrillation before heart transplantation is a risk factor for post‐transplant atrial fibrillation and mortality

Ablation as first-line treatment for asymptomatic atrial fibrillation in the context of conduction disturbances: Case report

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