Thermal catheter ablation for atrial fibrillation caused sustained decreases in HRV (10-20 ms) and increases in daytime (10 bpm) and nighttime (7 bpm) heart rates for 36 months (P<0.0001).
RCT (n=346)
Does pulmonary vein isolation using thermal ablation energy cause long-term autonomic alterations in patients with drug-refractory paroxysmal atrial fibrillation?
Catheter ablation for atrial fibrillation induces sustained autonomic alterations (decreased HRV, increased heart rate) for up to 3 years, which are associated with improved procedural success regardless of the thermal energy source used.
p-value: p=<0.0001
BACKGROUND: The long-term natural history of autonomic alterations following catheter ablation of drug-refractory paroxysmal atrial fibrillation is poorly defined. OBJECTIVES: The authors sought to define the long-term impact of thermal catheter ablation on the cardiac autonomic system. METHODS: The study included 346 patients with drug-refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using thermal ablation energy (radiofrequency or cryoballoon ablation). All patients underwent insertion of a Reveal LINQ implantable cardiac monitor prior to ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (HRV) (measured as the standard deviation of the average normal-to-normal), daytime heart rate, and nighttime heart rate (NHR). Longitudinal autonomic data in the 2-month period prior to the date of ablation were compared with the 3 years following ablation. RESULTS: Following ablation, there was a significant decrease in HRV (10-20 ms; P < 0.0001) and significant increases in daytime heart rate and NHR (10 beats/min P < 0.0001 and 7 beats/min P < 0.0001, respectively). Changes in autonomic parameters were greatest in the first 3 months following ablation but remained significantly different from baseline for 36 months following ablation. Greater changes in NHR and HRV were associated with improved freedom from recurrent arrhythmia. The type of thermal ablation energy had no influence on the heart rate and autonomic parameters. CONCLUSIONS: Pulmonary vein isolation using thermal ablation energy results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are independent of the ablation technology employed and are associated with procedural success. (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double Short vs Standard Exposure Duration CIRCA-DOSE; NCT01913522).
Andrade et al. (Thu,) conducted a rct in drug-refractory paroxysmal atrial fibrillation (n=346). Thermal catheter ablation (radiofrequency or cryoballoon) vs. Baseline (2 months prior to ablation) was evaluated on Heart rate variability, daytime heart rate, and nighttime heart rate (p=<0.0001). Thermal catheter ablation for atrial fibrillation caused sustained decreases in HRV (10-20 ms) and increases in daytime (10 bpm) and nighttime (7 bpm) heart rates for 36 months (P<0.0001).