Key result
Low rMSSD 1-2 days post-PVI predicts ~50% lower risk of AF recurrence.
Why the study?
The relationship between heart rate variability and atrial fibrillation recurrence after pulmonary vein isolation by cryoballoon or radiofrequency ablation required investigation.
Does low heart rate variability early after pulmonary vein isolation predict atrial fibrillation recurrence in patients with atrial fibrillation?
Observational (n=497)
No
Does low heart rate variability early after pulmonary vein isolation predict atrial fibrillation recurrence in patients with atrial fibrillation?
Effect estimate: HR 0.50 (95% CI 0.29-0.85)
Absolute Event Rate: 76.2% vs 56.5%
p-value: p=<0.001
Low heart rate variability (specifically rMSSD) measured early after pulmonary vein isolation is an independent predictor of freedom from atrial fibrillation recurrence, particularly following second-generation cryoballoon ablation.
May inform post-PVI risk models; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: This retrospective observational study investigated the relationship between heart rate variability (HRV) and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) by cryoballoon or radiofrequency ablation (RF). METHODS: We enrolled 497 patients who underwent PVI using first-generation cryoballoon (CB1), second-generation cryoballoon (CB2), or RF. We analyzed HRV as a surrogate for modulation of the intrinsic autonomic nervous system using 24‑h Holter recordings 1 or 2 days after the procedure and compared the recurrence and non-recurrence group with regard to ablation methods. Furthermore, we calculated recurrence-free survival (RFS) below/over HRV cut-off values for the whole study population and separately for each ablation method. RESULTS: All except one of the five time-based HRV parameters analyzed were significantly lower in the non-recurrence group than in the recurrence group after CB2. Only a trend toward lower HRV for the non-recurrence group was found after RF and no remarkable differences were detected after CB1. The HRV parameters below their calculated cut-off were associated with a significantly higher RFS rate 2 years after CB2. This also applied to root mean sum of squared distance (rMSSD) and the percentage of adjacent NN interval differences greater than 50 ms (pNN50) after RF. No differences were found regarding CB1. Concerning rMSSD, the sensitivity, specificity, and difference in RFS increased when using cut-offs that were calculated including only CB2 patients. Multivariate cox regression analysis showed that low rMSSD values could independently predict AF recurrence after adjusting for covariates (hazard ratio: 0.50; p < 0.001). CONCLUSION: Low values of rMSSD early after a PVI could independently predict AF recurrence, especially after CB2.
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Drexler et al. (2023) conducted an observational in Atrial fibrillation (n=497). Low rMSSD (root mean square of successive differences) vs. High rMSSD was evaluated on Atrial fibrillation recurrence-free survival at 2 years (HR 0.50, 95% CI 0.29-0.85, p=<0.001). Low rMSSD values 1-2 days after pulmonary vein isolation independently predicted a 50% lower risk of atrial fibrillation recurrence (HR 0.50).
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