Pulmonary vein isolation in a real-world population does not influence QTc interval

Abstract

Aims We aimed to examine whether routine pulmonary vein isolation (PVI) induces significant ventricular repolarization changes as suggested earlier. Methods and results Five-minute electrocardiograms were recorded at hospital’s admission (T−1d), 1 day after the PVI-procedure (T+1d) and at 3 months post-procedure (T+3m) from a registry of consecutive atrial fibrillation (AF) patients scheduled for routine PVI with different PVI modalities (radiofrequency, cryo-ablation, and hybrid). Only patients who were in sinus rhythm at all three recordings (n = 117) were included. QT-intervals and QT-dispersion were evaluated with custom-made software and QTc was calculated using Bazett’s, Fridericia’s, Framingham’s, and Hodges’ formulas. Both QT- and RR-intervals were significantly shorter at T+1d (399 ± 37 and 870 ± 141 ms) and T+3m (407 ± 36 and 950 ± 140 ms) compared with baseline (417 ± 36 and 1025 ± 164 ms). There was no statistically significant within-subject difference in QTc Fridericia (T−1d 416 ± 28 ms, T+1d 419 ± 33 ms, and T+3m 414 ± 25 ms) and QT-dispersion (T−1d 18 ± 12 ms, T+1d 21 ± 19 ms, and T+3m 17 ± 12 ms) between the recordings. A multiple linear regression model with age, sex, AF type, ablation technique, first/re-do ablation, and AF recurrence to predict the change in QTc at T+3m with respect to QTc at T−1d did not reach significance which indicates that the change in QTc does not differ between all subgroups (age, sex, AF type, ablation technique, first/re-do ablation, and AF recurrence). Conclusion Based on our data a routine PVI does not result in a prolongation of QTc in a real-world population. These findings, therefore, suggest that there is no need to intensify post-PVI QT-interval monitoring.

Corrected QT interval prolongation after ganglionated plexus ablation: myth or reality?—Authors’ reply

“…We thank Prof. Aksu for this valuable and well-balanced discussion on the possible effect of ablation of atrial ganglionated plexuses (GPs) on the QT interval. 1 Their comments are in line with our statement that from our study 2 we neither can conclude that pulmonary vein isolation (PVI) does not modulate GP nor that GP modulation leads to changes in QTc. We can, however, conclude that, on average, routine PVI does not induce changes in QTc.…”

QTc shortening effect of ganglionated plexi ablation: A miraculous phenomenon?

“…One study confirmed significant QTc prolongation by ~25 ms immediately after the atrial fibrillation ablation, by ~10–15 ms after 1 day, and by ~5–10 ms after 1 and 3 months (already nonsignificant) 2 . The other study did not find any meaningful change in QTc both after 1 day and 3 months following the atrial fibrillation ablation 3 . One may argue that such patients were much older and likely had more comorbidities compared to typical candidates of cardioneuroablation.…”

Does pulmonary vein isolation prolong QT-interval?— Authors’ reply

“…that AAD might affect both the RR- and QT-interval in our study and could be an explanation for the differences in raw RR- and QT-intervals between their and our study. However, as we already mentioned in the discussion of our original paper, 2 we believe that our study population better reflects the real-world population of patients undergoing pulmonary vein isolation since these patients are frequently treated with AAD before ablation. Therefore, we believe we induce a bias if we would only include patients without AAD.…”

“…We would like to thank you for the opportunity to respond to the issues raised in Dr Chikata’s letter titled ‘Does pulmonary vein isolation prolong QT-interval’. 1 In their letter to the editor, they raise three concerns regarding our study 2 which we will further discuss in this response: (1) the use of an automated algorithm to measure the QT-interval; (2) the use of antiarrhythmic drugs (AAD) in our study population, and (3) the heart rate correction methods for QT-intervals. 1…”