Prediction of atrial fibrillation recurrence after pulsed field ablation and radiofrequency ablation using HRV analysis

Background Pulsed field ablation (PFA) as well as radiofrequency ablation (RFA) represent effective treatments for atrial fibrillation (AF). However, the prediction of procedure success from preoperative parameters remains unresolved. The study focused on identifying preoperative predictors of heart rate variability (HRV) parameters that predict the maintenance of sinus rhythm 12 months after ablation. Methods Study enrolled patients undergoing catheter ablation for AF who were in sinus rhythm at the start of the procedure. ECG was recorded in all patients for 5-minutes immediately before the procedure., The offline HRV analysis was performed using Kubios software. Recurrence was monitored for 12 months through outpatient check-ups and Holter ECGs at 3, 6, 9, and 12 months. Results The study included 86 patients (age 62 ± 11 years, 30% females, BMI 29.1±5.4). 23 patients underwent RF and 63 PF ablation. Recurrence of AF was present in 22 (25%) during 12 months. Univariate logistic regression revealed RMSSD (root mean square difference of consecutive RR intervals, OR 0.98, p = 0.04), pNN50 (percentage of consecutive RR intervals differing by more than 50 ms, OR = 0.97, p = 0.04), SD1/SD2 (ratio between standard deviation perpendicular to and longitudinal to the identity axis in the Poincaré plot, OR = 2.73, p = 0.021) as significant predictors of AF recurrence. The AUC of the multivariate Lasso regression model, including clinical data (age, gender, weight, AF form), was 0.75. By expanding to include HRV parameters, AUC reached 0.79. Conclusion HRV from recordings obtained at the start of the procedure may contribute to better understanding of the predictors of SR maintenance after catheter ablation. Patients with AF recurrence experience higher parasympathetic activity (higher RMSSD, pNN50). It indicates an association between increased vagal tone and higher risk of AF recurrence.