Nocturnal blood pressure pattern on ambulatory blood pressure monitoring and recurrence after pulmonary vein isolation for atrial fibrillation

BACKGROUND: Nocturnal blood pressure patterns reflect autonomic and volume-related stress and may affect outcomes after pulmonary vein isolation (PVI). We examined their association with atrial fibrillation recurrence after PVI using ambulatory blood pressure monitoring (ABPM). METHODS AND RESULTS: We retrospectively studied 74 consecutive patients with preprocedural ABPM. Patients were classified as dipper (≥10% nocturnal systolic blood pressure decline), nondipper (0 to <10%), or riser (nighttime > daytime blood pressure). Recurrence was defined as any documented atrial tachyarrhythmia lasting greater than or equal to 30 s after the 90-day blanking period; episodes beginning during blanking and persisting beyond day 90 were assigned to day 90. Recurrence occurred in 27 patients (36.5%). Pattern distribution differed significantly by recurrence status (P = 0.002), with recurrence rates of 26.1% in dippers, 31.0% in nondippers, and 88.9% in risers. Kaplan-Meier analysis showed significantly lower freedom from recurrence in risers (log-rank P < 0.001). In univariable Cox analysis using dippers as the reference, risers were associated with recurrence (hazard ratio: 9.50, 95% confidence interval: 3.22-27.97; P < 0.001), whereas nondippers were not. In an exploratory multivariable model including nocturnal blood pressure pattern, persistent atrial fibrillation, and age, the riser pattern remained associated with recurrence (hazard ratio: 9.53, 95% confidence interval: 3.00-30.29; P < 0.001). CONCLUSION: The riser pattern on ABPM was associated with early postblanking recurrence after PVI and may provide complementary information for risk stratification.