Key result
SDNN reduction ≤25 ms at 3 months post-CPVI predicts ~152% higher late AF recurrence.
Why the study?
Incidental parasympathetic ganglia lesions during circumferential pulmonary vein isolation may alter heart rate variability, but the pattern of these changes and their relationship to atrial fibrillation recurrence were unclear.
Does the pattern of heart rate variability changes after circumferential pulmonary vein isolation predict long-term arrhythmia recurrence in patients with paroxysmal atrial fibrillation?
Cohort (n=100)
No
Does the pattern of heart rate variability changes after circumferential pulmonary vein isolation predict long-term arrhythmia recurrence in patients with paroxysmal atrial fibrillation?
Hazard Ratio: 2.52 (95% CI 1.3–4.89)
p-value: p=0.01
Sustained parasympathetic denervation, indicated by a >25 ms reduction in SDNN at 3 months post-ablation, serves as a marker for successful pulmonary vein isolation and predicts freedom from late AF recurrence.
Persistent post-CPVI HRV attenuation may flag lower late AF recurrence risk; leaves open prospective validation before guiding follow-up.
BACKGROUND: An incidental lesion of the parasympathetic ganglia during circumferential pulmonary vein isolation (CPVI) may affect heart rate variability (HRV). AIMS: We studied the pattern of changes in HRV parameters and the relationship between the 1‑year HRV change following CPVI and the recurrence of atrial fibrillation (AF). METHODS: A total of 100 consecutive patients undergoing CPVI for paroxysmal AF were enrolled (mean [SD] age, 56 [11.2] years; 61 men). We measured HRV on the day before and after CPVI, and then at 1 month as well as 3, 6, and 12 months after CPVI using 24‑hour Holter monitoring. RESULTS: During the median follow‑up of 33 months, 38 patients experienced the late recurrence of AF (LRAF). Compared with the pre‑CPVI values, HRV was significantly attenuated on day 1 after CPVI in all patients. However, at 3 to 6 months after CPVI, all HRV parameters remained significantly decreased in LRAF‑free patients but not in those with LRAF. The multivariate Cox analysis showed that early AF recurrence within the blanking period (hazard ratio [HR], 4.87; 95% CI, 2.44–9.69; P <0.001) and a change in the standard deviation of normal‑to‑normal intervals (SDNN) observed 3 months after ablation (HR, 0.99; 95% CI, 0.98–1; P = 0.01) were associated with LRAF. The cumulative LRAF freedom after CPVI was greater in patients with an SDNN reduction of more than 25 ms reported 3 months after ablation than in those with a reduction of 25 ms or lower (log‑rank P = 0.004). CONCLUSIONS: Sustained parasympathetic denervation during 12 months after CPVI was a marker of successful CPVI, whereas a 3‑month post‑CPVI SDNN reduction of 25 ms or lower predicted LRAF.
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Marinković et al. (2020) conducted a cohort in Paroxysmal atrial fibrillation (n=100). SDNN reduction of 25 ms or lower at 3 months post-ablation vs. SDNN reduction of more than 25 ms was evaluated on Late recurrence of atrial fibrillation (LRAF) (HR 2.52, 95% CI 1.30-4.89, p=0.01). A reduction in the standard deviation of normal-to-normal intervals of 25 ms or lower at 3 months after circumferential pulmonary vein isolation predicted late recurrence of atrial fibrillation (HR 2.52).
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