Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

Abstract

Introduction Ablation of atrial vagal ganglia has been associated with improved pulmonary vein isolation (PVI) outcomes. Disruption of vagal reflexes results in heart rate (HR) increase. We investigated the association between HR change after PVI and freedom from atrial fibrillation (AF) at 1 year. Methods and Results Patients who underwent PVI for paroxysmal AF were identified from the Johns Hopkins Hospital AF registry. Electrocardiograms taken pre‐PVI and post‐PVI were used to determine the change in HR. Patients followed‐up at 3, 6, and 12 months. Of 257 patients (66% male, age 59+/‐11 years), 134 (52%) remained free from AF at 1 year. The average HR increased from 60.6 ± 11.3 beats per minute (bpm) pre‐PVI to 70.7 ± 12.0 bpm post‐PVI. Patients with recurrence of AF had lower post‐PVI HR than those who remained free from AF (67.8 ± 0.2 vs 73.3 ± 13.0 bpm; P <.001). The probability of AF recurrence at 1‐year decreased as the change in HR increased (estimated odds ratio [OR], 0.83; 95% confidence interval [CI, 0.74‐0.93]; P = .002). HR increase more than 15 bpm was associated with the lowest odds of AF recurrence (estimated OR, 0.39; 95% [0.17‐0.85]; P = .018) compared to HR decrease. Conclusions Resting HR was found to increase after PVI. Increase in HR more than 15 bpm has a positive association with remaining free from atrial fibrillation at 1 year.

Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation

“…Due to the different techniques and study designs in clinical studies in the literature, it is difficult to assess and make a true comparison of success. HRV has been found to be a predictor of ablation success and is a useful, non-invasive tool for investigating cardiac autonomic tone [ 130 , 131 ]. HRV measures the fluctuations of time intervals between consecutive heartbeats [ 132 ].…”

“…HRV measures the fluctuations of time intervals between consecutive heartbeats [ 132 ]. An increased heart rate has been found to have positive associations with freedom from AF [ 130 ]. A recent study by Goff et al showed a correlation between HRV in patients with paroxysmal AF who previously underwent PVI and the recurrence of AF [ 130 ].…”

“…An increased heart rate has been found to have positive associations with freedom from AF [ 130 ]. A recent study by Goff et al showed a correlation between HRV in patients with paroxysmal AF who previously underwent PVI and the recurrence of AF [ 130 ]. While HRV is not always associated with PVI, an average increase of 60.6 ± 11.3 to 70.7 ± 12.0 beats per minute was recorded in 53% of patients at 12 months follow-up in this study [ 130 ].…”

“…A recent study by Goff et al showed a correlation between HRV in patients with paroxysmal AF who previously underwent PVI and the recurrence of AF [ 130 ]. While HRV is not always associated with PVI, an average increase of 60.6 ± 11.3 to 70.7 ± 12.0 beats per minute was recorded in 53% of patients at 12 months follow-up in this study [ 130 ]. Overall, it is evident that sufficient disruption of vagal responses results in an increased HR and freedom from AF.…”

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

“…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. In this context, it has been shown that a low sinus heart rate postablation is associated with a significantly higher recurrence risk of atrial fibrillation during follow-up [8][9][10]. However, studies were either limited by sample size or timepoints for significant changes in sinus heart rate differed.…”