Sinus rhythm heart rate increase after atrial fibrillation ablation is associated with lower risk of arrhythmia recurrence

Abstract

Background Pulmonary vein isolation (PVI) with autonomic modulation may be more successful than PVI alone for atrial fibrillation (AF) ablation and may be signaled by changes in sinus rhythm heart rate (HR) post ablation. We sought to determine if a change in sinus rhythm HR predicted AF recurrence post PVI. Methods Patients who underwent AF ablation from 2000 to 2011 were included if sinus rhythm was noted on ECG within 90 days pre and 7 days post ablation. Basic ECG interval and HR changes were analyzed and outcomes determined. Results A total of 1152 patients were identified (74.3% male, mean age 57 ± 11 years). Mean AF duration was 5.2 ± 5.3 years. Paroxysmal AF was noted in 712 (61.8%) of the patients. Mean EF was 61% ± 6%. Sinus rhythm HR was 61 ± 11 pre‐ablation and 76 ± 13 bpm post‐ablation (27% ± 24% increase, p < .001). The ability of relative HR change post‐ablation to predict AF recurrence was borderline (hazard ratio 0.65 [0.41–1.01], p = .067). With patients separated into quartiles based on the relative HR change, the upper quartile with the largest relative increase in HR had a significantly lower rate of AF recurrence compared to the lowest quartile following multi variable modeling (p = .038). There were significant changes in PR (171 ± 28 to 167 ± 30 ms) and QTc (424 ± 25 to 434 ± 29 ms) intervals (both p < .001) but these were not predictive of outcome. Conclusion Relative changes in HR post AF ablation correlates with AF recurrence. Further prospective studies are needed to confirm this relationship.

Heart rate increase and inappropriate sinus tachycardia after cryoballoon pulmonary vein isolation for atrial fibrillation

“…We observed a significant increase in HR after PVI. Several studies have found an association between an increase in HR and AF-free survival [10,13,19]. For our patients with an increased HR after PVI, this would imply a lower risk of AF recurrence compared with patients with no or a lower increase.…”

“…However, with the current techniques, it is difficult to explore the exact role of the CANS in AF development. The role of the CANS in AF development together with the observation that cryoballoon PVI is associated with modulation of the CANS (leading to an increase in HR) may explain the association of an increase in HR after PVI with AF-free survival [19].…”

“…There was no significant difference in patient characteristics between the groups with and without CANS modulation, which is comparable to our findings. Killu et al included 1152 patients with radiofrequency PVI and reported a significant increase in HR, from 61 ± 11 to 76 ± 13 bpm post-ablation [19].…”