Key result
A relative increase in sinus rhythm heart rate following atrial fibrillation ablation was associated with a borderline lower risk of AF recurrence (HR 0.65; 95% CI 0.41-1.01; p=0.067).
Why the study?
PVI with autonomic modulation may be more successful than PVI alone and may be signaled by sinus rhythm HR changes, but whether HR change predicts AF recurrence was unclear.
Does a larger relative increase in sinus rhythm heart rate post atrial fibrillation ablation predict a lower risk of AF recurrence?
Cohort (n=1,152)
Does a larger relative increase in sinus rhythm heart rate post atrial fibrillation ablation predict a lower risk of AF recurrence?
A larger relative increase in sinus rhythm heart rate following atrial fibrillation ablation is associated with a significantly lower risk of arrhythmia recurrence, potentially signaling successful autonomic modulation.
Answers are grounded in this paper and cite their sources.
May signal lower AF recurrence risk post-ablation; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Pulmonary vein isolation (PVI) with autonomic modulation may be more successful than PVI alone for atrial fibrillation (AF) ablation and may be signaled by changes in sinus rhythm heart rate (HR) post ablation. We sought to determine if a change in sinus rhythm HR predicted AF recurrence post PVI. METHODS: Patients who underwent AF ablation from 2000 to 2011 were included if sinus rhythm was noted on ECG within 90 days pre and 7 days post ablation. Basic ECG interval and HR changes were analyzed and outcomes determined. RESULTS: A total of 1152 patients were identified (74.3% male, mean age 57 ± 11 years). Mean AF duration was 5.2 ± 5.3 years. Paroxysmal AF was noted in 712 (61.8%) of the patients. Mean EF was 61% ± 6%. Sinus rhythm HR was 61 ± 11 pre-ablation and 76 ± 13 bpm post-ablation (27% ± 24% increase, p < .001). The ability of relative HR change post-ablation to predict AF recurrence was borderline (hazard ratio 0.65 [0.41-1.01], p = .067). With patients separated into quartiles based on the relative HR change, the upper quartile with the largest relative increase in HR had a significantly lower rate of AF recurrence compared to the lowest quartile following multi variable modeling (p = .038). There were significant changes in PR (171 ± 28 to 167 ± 30 ms) and QTc (424 ± 25 to 434 ± 29 ms) intervals (both p < .001) but these were not predictive of outcome. CONCLUSION: Relative changes in HR post AF ablation correlates with AF recurrence. Further prospective studies are needed to confirm this relationship.
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Killu et al. (2021) conducted a cohort in Atrial fibrillation (n=1,152). Relative increase in sinus rhythm heart rate post-ablation vs. Lower relative heart rate change was evaluated on Atrial fibrillation recurrence (HR 0.65, 95% CI 0.41-1.01, p=0.067). A relative increase in sinus rhythm heart rate following atrial fibrillation ablation was associated with a borderline lower risk of AF recurrence (HR 0.65; 95% CI 0.41-1.01; p=0.067).
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