Key result
Pulmonary vein isolation for atrial fibrillation significantly increased mean QTc from 446.3 ms at baseline to 471.7 ms on postoperative day 0 (P<.001), returning to baseline by 1 month.
Why the study?
Pulmonary vein isolation may increase QTc duration, but its effects, incidence, risk factors, and clinical outcomes have not been well studied.
Does pulmonary vein isolation cause clinically significant QTc prolongation and ventricular arrhythmias in patients with atrial fibrillation?
Cohort (n=352)
No
Does pulmonary vein isolation cause clinically significant QTc prolongation and ventricular arrhythmias in patients with atrial fibrillation?
Absolute Event Rate: 471.7% vs 446.3%
p-value: p=<.001
Pulmonary vein isolation for atrial fibrillation causes transient but significant QTc prolongation in the immediate postoperative period, which resolves by 1 month without provoking ventricular arrhythmias.
Transient QTc prolongation after PVI may warrant short-term monitoring; leaves open arrhythmic outcome implications.
Background The corrected QT interval (QTc) is a measure of ventricular repolarization time, and a prolonged QTc increases risk for malignant ventricular arrhythmias. Pulmonary vein isolation (PVI) may increase QTc but its effects have not been well studied. Objective Determine the incidence, risk factors, and outcomes of patients presenting for PVI in sinus and atrial fibrillation with postoperative QTc prolongation in a large cohort. Methods We performed a single-center retrospective study of consecutive atrial fibrillation ablations. QTc durations using Bazett correction were obtained from electrocardiograms at different postoperative intervals and compared to preoperative QTc. We studied clinical outcomes including clinically significant ventricular arrhythmia and death. A multivariable model was used to identify factors associated with clinically significant QTc prolongation, defined as ΔQTc ≥60 ms or new QTc duration ≥500 ms. Results A total of 352 PVIs were included in this study. We observed a statistically significant increase in mean QTc compared to baseline (446.3 ± 37.8 ms) on postoperative day (POD)0 (471.7 ± 38.2 ms, P < .001) and at POD1 (456.5 ± 35.0 ms, P < .001). There was no significant difference at 1 month (452.4 ± 33.5 ms, P = .39) and 3 months (447.3 ± 40.0 ms, P = .78). Sixty-six patients (19.2%) developed ΔQTc ≥60 ms or QTc ≥500 ms on POD0, with 4.1% persisting past 90 days. Female sex (odds ratio [OR] = 1.82, 95% confidence interval [CI] =1.01–3.29, P = .047) and history of coronary artery disease (OR = 2.16, 95% CI=1.03–4.55, P = .042) were independently predictive of QTc prolongation ≥500 ms or ΔQTc ≥60 ms. There were no episodes of clinically significant ventricular arrhythmia or death attributable to arrhythmia. Conclusion QTc duration increased significantly immediately post-PVI and returned to baseline by 1 month. PVI did not provoke significant ventricular arrhythmias in our cohort.
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Nguyen et al. (2021) conducted a cohort in atrial fibrillation (n=352). Pulmonary vein isolation (PVI) vs. baseline was evaluated on mean QTc on postoperative day 0 (p=<.001). Pulmonary vein isolation for atrial fibrillation significantly increased mean QTc from 446.3 ms at baseline to 471.7 ms on postoperative day 0 (P<.001), returning to baseline by 1 month.
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