Key result
Cryoballoon PVI is linked to an abnormal sinus heart rate response in ~4% of patients.
Why the study?
While moderately increased sinus rhythm heart rate after cryoballoon PVI has been observed, inappropriate sinus tachycardia is rare, and the prevalence and natural history of an abnormal sinus heart rate response remained unclear.
Does cryoballoon pulmonary vein isolation cause an abnormal sinus heart rate response or inappropriate sinus tachycardia in patients with atrial fibrillation?
Observational (n=169)
No
Does cryoballoon pulmonary vein isolation cause an abnormal sinus heart rate response or inappropriate sinus tachycardia in patients with atrial fibrillation?
Cryoballoon pulmonary vein isolation for atrial fibrillation leads to a moderate, sustained increase in resting heart rate up to 12 months, but inappropriate sinus tachycardia is rare and typically resolves within a year.
Answers are grounded in this paper and cite their sources.
Reassures clinicians that inappropriate sinus tachycardia remains rare after cryoballoon PVI; leaves open mechanisms and relevance of sustained heart-rate elevation.
BACKGROUND: Cryoballoon pulmonary vein isolation (PVI) is a common therapy for atrial fibrillation (AF). While moderately increased sinus rhythm heart rate (HR) after PVI has been observed, inappropriate sinus tachycardia (IST) is a rare phenomenon. We aimed to investigate the prevalence and natural history of an abnormal sinus HR response after cryoballoon PVI. METHODS: We included 169/646 (26.2%) patients with AF undergoing PVI with available Holter recordings before and 3, 6 and 12 months after the procedure. Patients with AF on Holter monitoring were excluded. Mean HR increase ≥ 20 bpm or an IST-like pattern (mean HR > 90 bpm or > 80 bpm when beta-blocking agents were used) following PVI was categorised as abnormal sinus HR response. RESULTS: Following PVI, mean HR ± standard deviation increased in the entire group from 63.5 ± 8.4 to 69.1 ± 9.9 bpm at 3 months (p < 0.001), and to 71.9 ± 9.4 bpm at 6 months (p < 0.001). At 12 months, mean HR was 71.2 ± 10.1 bpm (p < 0.001). Only 7/169 patients (4.1%) met criteria for abnormal sinus HR response: mean HR was 61.9 ± 10.6 bpm (pre-ablation), 84.6 ± 9.8 bpm (3 months), 80.1 ± 6.5 bpm (6 months) and 76.3 ± 10.1 bpm (12 months). Even at 12 months, mean HR was significantly different from that pre-ablation in this group (p = 0.033). However, in patients meeting IST-like pattern criteria, mean HR at 12 months was no longer significantly different from that pre-ablation. CONCLUSION: Few patients had an abnormal sinus HR response after PVI. Peak HR was observed 3 months after PVI, but HR was still significantly increased 12 months post-ablation compared with pre-ablation. An IST-like pattern was rarely observed. In these patients, HR decreased to pre-ablation values within a year.
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Deutekom et al. (2021) conducted an observational in Atrial fibrillation (n=169). Cryoballoon pulmonary vein isolation vs. Pre-ablation baseline was evaluated on Incidence of abnormal sinus heart rate response (mean HR increase ≥20 bpm or inappropriate sinus tachycardia-like pattern). An abnormal sinus heart rate response after cryoballoon pulmonary vein isolation was observed in only 4.1% of patients, with mean heart rate remaining significantly elevated at 12 months compared to pre-ablation.
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