Why the study?
There is a shortage of adequate studies evaluating the effectiveness and safety of antiarrhythmic drugs following circumferential pulmonary vein isolation, especially given their arrhythmogenic risks.
Does low-dose metoprolol succinate improve heart rate variability parameters or reduce arrhythmias in patients with paroxysmal atrial fibrillation post-circumferential pulmonary vein isolation?
Does low-dose metoprolol succinate improve heart rate variability parameters or reduce arrhythmias in patients with paroxysmal atrial fibrillation post-circumferential pulmonary vein isolation?
Low-dose metoprolol succinate post-CPVI does not significantly alter short-term heart rate variability or arrhythmia burden, though CPVI itself causes transient autonomic dysfunction that normalizes by 3 months.
Answers are grounded in this paper and cite their sources.
Low-dose metoprolol shows no HRV or arrhythmia benefit post-CPVI; leaves open its role in randomized trials.
BACKGROUND: The atria, particularly those near the pulmonary vein ostium, have numerous autonomic neural plexuses. Circumferential pulmonary vein isolation (CPVI) can reduce heart rate variability (HRV) parameters. Studies have suggested that continuing antiarrhythmic drugs (AADs) for 1year post-CPVI can reduce the recurrence of atrial arrhythmias within the year. However, the arrhythmogenic risk associated with AADs is notable. Currently, there is a shortage of adequate studies on the effectiveness and safety of using AADs following CPVI. This exploratory study evaluated the impact of low-dose sustained-release metoprolol succinate on Holter in individuals with paroxysmal atrial fibrillation (PAF) after CPVI. METHODS: Patients with PAF who underwent initialCPVI at Shaoxing People's Hospital between September 2022 and January 2024 were retrospectively enrolledusing the electronic medical record system. Patients underwent 24-h Holter monitoring before the procedureand at 1 - 3, 6, 12, and 18 months afterthe procedure. The participantswere separated into medication and non-medication groupsaccording to their heart rate and clinical experience. RESULTS: Overall, 67 patients completed the 24-h Holter monitoring, with 33 receiving low-dose metoprolol succinate (23.75 mg/day)(medication group) and 34 not receiving AADs (non-medication group). No significant differences were observed in HRV parameters and arrhythmia data between the two groups or across the different time points. CONCLUSIONS: Oral low-dose sustained-release metoprolol succinate tablets may have no significant short-term effects on HRV parameters or arrhythmia data in patients with PAF post-CPVI. CPVI can cause autonomic dysfunction, and HRV parameters were gradually restored to normal 3months post-procedure.
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Ding et al. (2025) studied this question.
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