Prolongation of QT interval after pulmonary vein isolation for paroxysmal atrial fibrillation

Abstract

Introduction Pulmonary vein isolation (PVI) affects the ganglionated plexi (GP) around the atrium leading to a modification of intrinsic cardiac autonomic system (ANS). In animal models, GP ablation has the potential risk of QT prolongation and ventricular arrhythmias. However, the impact of PVI on QT intervals in human remains unclear. Methods and Results We analyzed electrocardiograms of 117 consecutive patients with paroxysmal atrial fibrillation (AF) who underwent their first PVI procedures and maintained sinus rhythm without antiarrhythmic drugs at all evaluation points (4 h, 1 day, 1 month, and 3 months after PVI). Heart rate significantly increased at 4 h, 1 day, and 1 month. Raw QT interval prolonged at 4 h (417.1 ± 41.6 ms, p < .001) but shortened at 1 day (376.4 ± 34.1 ms, p < .001), 1 month (382.2 ± 31.5 ms, p < 0.001), and 3 months (385.1 ± 32.8 ms, p < 0.001) compared with baseline (391.6 ± 31.4 ms). Bazett‐corrected QTc intervals were significantly prolonged at 4 h (430.8 ± 27.9 ms, p < .001), 1 day (434.8 ± 22.3 ms, p < .001), 1 month (434.8 ± 22.3 ms, p < .001), and 3 months (420.1 ± 21.8 ms, p < .001) compared with baseline (404.9 ± 25.2 ms). Framingham‐corrected QTc intervals significantly prolonged at 4 h (424.1 ± 26.6 ms, p < .001) and 1 day (412.3 ± 29.3 ms, p < .01) compared with baseline (399.2 ± 22.7 ms). Multiple regression analysis revealed that female sex is a significant predictor of raw QT and QTc interval increase at 4 h after PVI. Conclusion Raw QT and QTc were prolonged after PVI, especially in the acute phase. Female sex is a risk factor for QT increase.

QTc shortening effect of ganglionated plexi ablation

“…The current study is the first one studying and comparing the effects of GP ablation and GP ablation plus PVI on QTc in patients undergoing the procedure with different indications during medium‐term follow‐up. Although previous studies suggested that surgical ablation of GPs or endocardial PVI may cause a prolongation on QTc, 6,7 we found significant and durable shortening of QTc after GP ablation in patients with normal QTc range and long QT syndrome 3,5 . A similar QTc shortening effect after GP ablation was confirmed regardless of additional PVI in the present study.…”

Pulmonary vein isolation and QT prolongation in paroxysmal atrial fibrillation: What have we learned?

“…9 PVI affects the atrial GP, modifies the intrinsic cardiac autonomic nervous system and could lead to QT prolongation and lethal ventricular arrhythmias such as torsade de pointe and ventricular tachycardia. 10 In their study published in this issue of the Journal of Cardiovascular Electrophysiology, Chikata et al 11 Furthermore, the study showed that in the acute phase post-PVI, women had significantly prolonged QTc interval as compared with their baseline and to men (p < .05).…”

“…12 That could be explained by the hormonal effect on the expression of ion channels and by the difference in autonomic regulation between genders. 13,14 Chikata et al 11 show a possible association between gender and QT prolongation post-PVI that might be explained by a difference in inflammatory response or a distinguished genetic predisposition found more frequently in J Cardiovasc Electrophysiol. 2020;31:2380-2381. wileyonlinelibrary.com/journal/jce 2380 | © 2020 Wiley Periodicals LLC women.…”

“…In their study published in this issue of the Journal of Cardiovascular Electrophysiology , Chikata et al 11 . investigated the effect of PVI on the QT interval in patients with paroxysmal AF and identified associated predisposing factors.…”

“…That could be explained by the hormonal effect on the expression of ion channels and by the difference in autonomic regulation between genders 13,14 . Chikata et al 11 show a possible association between gender and QT prolongation post‐PVI that might be explained by a difference in inflammatory response or a distinguished genetic predisposition found more frequently in women. Further investigation is warranted via prospective studies with larger sample size in the future to corroborate the findings especially with the relatively small sample size and the fact that it was a single‐center study.…”