Key result
Greater resting heart rate increase after PVI fails to predict lower long-term arrhythmia recurrence.
Why the study?
Increased resting heart rate after pulmonary vein isolation is common, and previous trials suggested it might correlate with higher efficacy, but whether it predicts better long-term outcomes in real-life paroxysmal AF ablation remained to be determined.
Does a higher increase in resting heart rate after radiofrequency pulmonary vein isolation prevent arrhythmia recurrence in patients with paroxysmal atrial fibrillation?
Cohort (n=146)
No
Does a higher increase in resting heart rate after radiofrequency pulmonary vein isolation prevent arrhythmia recurrence in patients with paroxysmal atrial fibrillation?
Effect estimate: HR 1.001 (95% CI 0.99-1.02)
p-value: p=0.84
An increase in resting heart rate after radiofrequency pulmonary vein isolation for paroxysmal atrial fibrillation does not predict long-term freedom from arrhythmia recurrence.
Background: Increased resting heart rate (RHR) after pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) is a common observation, possibly resulting from ganglionated plexus modification during ablation. Previous trials have suggested that an increase in RHR after ablation might be related to higher efficacy of the procedure. The aim of this study was to determine whether or not higher increase in RHR after radiofrequency (RF) PVI might predict better long-term outcome of the procedure in a real-life cohort of patients in whom index ablation for paroxysmal AF was performed. Material and methods: The health records of patients who underwent index point-by-point or drag lesion RF PVI for paroxysmal AF in our department between January 2014 and November 2018 were analyzed. Resting heart rate (RHR) was determined from 12-lead ECG recorded prior to the ablation and before discharge to evaluate changes in RHR after PVI. Only patients in sinus rhythm before the procedure and at discharge were included in the analysis. Telephone follow-up was collected for evaluation of arrhythmia recurrence status. Results: A total of 146 patients who underwent PVI for paroxysmal AF were included. Mean follow-up time was 3.5 years. RHR increased from 64 [58.5−70], prior to procedure, to 72 [64.25−80] bpm at discharge (p < 0.001). Higher increase in RHR was not protective from arrhythmia recurrence in long-term observation in both univariable HR = 1.001 (CI 0.99−1.017, p = 0.857) and multivariable analyses HR = 1.001 (CI 0.99−1.02, p = 0.84). Conclusions: RHR after PVI increased in comparison to baseline in our cohort. However, we did not observe higher increase in RHR to be associated with more favorable long-term effectiveness of the procedure.
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Maciejewski et al. (2022) conducted a cohort in Paroxysmal atrial fibrillation (n=146). Higher increase in resting heart rate after RF PVI vs. Lower increase in resting heart rate was evaluated on Arrhythmia recurrence (HR 1.001, 95% CI 0.99-1.02, p=0.84). A higher increase in resting heart rate after radiofrequency pulmonary vein isolation for paroxysmal AF was not associated with protection from long-term arrhythmia recurrence (HR 1.001; 95% CI 0.99-1.02; p=0.84).
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