Low heart deceleration capacity imply higher atrial fibrillation-free rate after ablation

Abstract

How deceleration capacity (DC) and acceleration capacity (AC) of heart rate associated with atrial fibrillation (AF) and ablation is still not clear. The dynamic changes of AC, DC and conventional heart rate variability (HRV) parameters were characterized in 154 subjects before circumferential pulmonary veins isolation (CPVI) and three days, 3 months and 6 months after CPVI. The DCs of the recurrent group decreased significantly at each time point after CPVI; the DCs of the recurrence-free group before CPVI and three days, 3 months and 6 months after CPVI were 7.06 ± 1.77, 3.79 ± 1.18, 4.22 ± 1.96 and 3.97 ± 0.98 ms respectively, which also decreased significantly at each time point and were significantly lower than these of recurrent group. Conversely, the AC of recurrent and recurrence-free groups increased significantly at each time point after CPVI; the ACs of recurrence-fee group were significantly higher than these of recurrent group at each time point. No stable difference trend of HRV parameters was found between two groups. Further Kaplan–Meier analysis showed that DC < 4.8 ms or AC ≥ −5.1 ms displayed significant higher recurrence-free rates. In conclusion, high AC and low DC imply higher AF-free rate after ablation.

A refined method of quantifying deceleration capacity index for heart rate variability analysis

“…Theoretically, DC index could reflect the cardiac vagal modulation on heart rate [7, 10, 13, 31, 32]. When applied PRSA to heartbeat intervals for assessing vagal tone modulation, the anchor points selected according to Eq.…”

“…When applied to heartbeat time series, the deceleration capacity (DC) of heart rate quantified by PRSA also reflects parasympathetic/vagal control of heart rate [7]. Despite the growing application of DC [8–13], the method is affected by one shortcoming: non-vagally mediated abnormal variants of sinus rhythms in heartbeat interval time series are used to quantify DC, thus confounding the evaluation of cardiac vagal modulation. Previous studies reported that the presence of erratic sinus rhythm, sinus alternans, and their variants, influence values of HRV indices including root-mean-square of successive differences of normal-to-normal interbeat intervals (rMSSD), the percentage of normal-to-normal intervals > 50 ms different from the previous interval (pNN50), and the amount of variance in normal-to-normal intervals at respiratory frequencies (HF, 0.15–0.4 Hz) [14–16].…”

High vagal tone predicts pulmonary vein reconnection after cryoballoon ablation for paroxysmal atrial fibrillation

“…ANS tone was assessed using (1) = 2 using up to 100,000 RR intervals from ambulatory monitoring, as described elsewhere. 3 For AC/DC measurement consecutive RR intervals varying more than 20% in length were automatically excluded from analysis to minimize artifacts interference, a cut-off value used by previous studies. 3 HRT parameters include TO and TS that were calculated from RR tachograms before and after a premature ventricular contraction (PVC).…”

“…3 For AC/DC measurement consecutive RR intervals varying more than 20% in length were automatically excluded from analysis to minimize artifacts interference, a cut-off value used by previous studies. 3 HRT parameters include TO and TS that were calculated from RR tachograms before and after a premature ventricular contraction (PVC). TO assesses early sinus rate acceleration and TS assesses late deceleration following PVC and the method of determination is described elsewhere.…”

“…1 Recent studies showed that AF recurrence is associated with increased parasympathetic tone. 3 On the other hand, the best strategy for repeated catheter ablation procedures is still under debate and may include re-isolation of reconnected PV-LA junctions, linear lesions, posterior box isolation, or complex fractionated atrial electrograms ablation. 1 Recent studies showed that repeated ablation with documentation of reconnected PVs and re-isolation is associated with better outcomes than repeated ablation with documented isolated PVs and extra-PVs foci ablation.…”