Improvement of Vascular Endothelial Function Reflects Nonrecurrence After Catheter Ablation for Atrial Fibrillation

Figures

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  Figure 1. Flowchart of the patient enrollment in this study. AF indicates atrial fibrillation; RH‐PAT, reactive hyperemia‐peripheral arterial tonometry; and SR, sinus rhythm.

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  Figure 2. Representative case of reactive hyperemia‐peripheral arterial tonometry measurement. A, The method of RH‐PAT measurement and the formula to calculate the RH‐PAT index (RHI). B, The representative result of RH‐PAT examination in patient with atrial fibrillation recurrence. C, The representative result of RH‐PAT examination in patients without atrial fibrillation recurrence. Since RH‐PAT measures arterial dilatation from a 3‐dimensional increase in the volumetric pulse wave of the fingertip arteriole vascular bed, the volume pulse wave change rate is large and the sensitivity of the data are also high. RH‐PAT may be more suitable for measurement even in pathological conditions such as atrial fibrillation, where the pulse wave varies for each pulse such as upper and lower figure in (B) and upper figure in (C) which recorded during atrial fibrillation. AF indicates atrial fibrillation; and LnRHI, natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index.

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  Figure 3. Comparison of the reactive hyperemia‐peripheral arterial tonometry index. A, The comparison of the LnRHI between in SR or in AF at the time of reactive hyperemia‐peripheral arterial tonometry measurement before CA. B and C, The comparison of LnRHI between before CA, 3 months after CA, and 6 months after CA in patients with (B) and without recurrence of AF (C). D, The change in LnRHI (ΔLnRHI) from before to 3 or 6 months after CA in patients with and without recurrence of AF. E, The comparison of LnRHI between in patients without AF recurrence, all recorded under SR (AF SR group), and in normal control subjects. The summary data of each parameter in (A, B, C, and E) are described by the box‐and‐whisker plot. In these plots, the lines within the boxes represent the median values. The upper and lower lines of the boxes represent the 25th and 75th percentiles, respectively. The upper and lower bars outside the boxes represent the 10th and 90th percentiles, respectively. The mean±SD value was described, and the mean values are connected by a line. Furthermore, the data in (D) are described by line chart. The central point represents the mean value and upper and lower point represent…

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  Figure 4. Receiver operating characteristic curve and Kaplan‒Meier analysis to identify the recurrence of atrial fibrillation. A, Receiver operating characteristic curve analysis. The value of LnRHI 3 months after catheter ablation, which decreased to ≥0.01 compared with that before catheter ablation, was an independent factor of atrial fibrillation recurrence (sensitivity, 0.806; specificity, 0.821; area under the curve, 0.792; P<0.001). B, Kaplan‒Meier analysis. The decrease group in LnRHI 3 months after catheter ablation compared with before catheter ablation (red) had a significantly higher probability of atrial fibrillation recurrence compared with the non‐decrease group (blue) (log‐rank test, P<0.001). AUC indicates area under the curve; CA, catheter ablation; and LnRHI, natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index.

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  Figure 5. Subanalysis of comparison of the reactive hyperemia‐peripheral arterial tonometry index before catheter ablation. A and B, The comparison of the LnRHI between in SR and in atrial fibrillation (AF) at the time of reactive hyperemia‐peripheral arterial tonometry (RH‐PAT) measurement before catheter ablation (CA) in patients with paroxysmal AF (A) and persistent AF (B). C, The comparison of LnRHI measured under SR at the time of RH‐PAT measurement before CA between in patients with paroxysmal AF and in patients with persistent AF. D, The comparison of LnRHI measured under AF rhythm at the time of RH‐PAT measurement before CA between in patients with paroxysmal AF and in patients with persistent AF. See Figure 3 for the box‐and‐whisker plot, and the mean±SD. AF indicates atrial fibrillation; LnRHI, natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index; and SR, sinus rhythm.

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  Figure 6. Subanalysis of serial changes in the reactive hyperemia‐peripheral arterial tonometry index. A and B, The serial changes of the natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index in patients with recurrence of atrial fibrillation (AF) measured under sinus rhythm (SR) before catheter ablation (CA) (A) and measured under AF rhythm (B). C and D, The serial changes of the LnRHI in patients with paroxysmal AF with recurrence (C) and patients with persistent AF with recurrence (D). E and F, The serial changes of the LnRHI in patients without recurrence of AF measured under SR before CA (E) and measured under AF rhythm (F). G and H, The serial changes of the LnRHI in patients with paroxysmal AF without recurrence (G) and patients with persistent AF without recurrence (H). See Figure 3 for the box‐and‐whisker plot, the mean±SD, and the line connecting the mean values. AF indicates atrial fibrillation; and LnRHI, natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index. [Corrections added on September 07, 2021, figure caption is updated to read correctly.]

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  Figure 7. Subanalysis of comparison of reactive hyperemia‐peripheral arterial tonometry index between patients without recurrence of atrial fibrillation and normal control subjects. A, The comparison of the natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry (RH‐PAT) index (LnRHI) between patients without atrial fibrillation (AF) recurrence in whom the AF rhythm was present at the time of the RH‐PAT measurement before catheter ablation (CA), and normal control subjects. B and C, The comparison of LnRHI between patients with paroxysmal AF without recurrence in whom the sinus rhythm (SR) (B) or AF rhythm (C) was present at the time of the RH‐PAT measurement before CA, and normal control subjects. D and E, the comparison of LnRHI between patients with persistent AF without recurrence in whom the sinus rhythm (D) or AF rhythm (E) was present at the time of the RH‐PAT measurement before CA, and normal control subjects. See Figure 3 for the box‐and‐whisker plot, the mean±SD, and the line connecting the mean values.

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  Figure 8. Comparison of the blood pressure according to the heart rhythm before catheter ablation and correlation between blood pressure and reactive hyperemia‐peripheral arterial tonometry index. A, The comparison of systolic blood pressure and diastolic blood pressure between in sinus rhythm or in atrial fibrillation at the time of reactive hyperemia‐peripheral arterial tonometry measurement before catheter ablation. B, The comparison of pulse pressure between in sinus rhythm or in atrial fibrillation at the time of reactive hyperemia‐peripheral arterial tonometry measurement before catheter ablation. C through E, The correlation between systolic blood pressure, diastolic blood pressure, or pulse pressure and the natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index. See Figure 3 for the box‐and‐whisker plot, and the mean±SD. AF indicates atrial fibrillation; LnRHI, natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index; and SR, sinus rhythm.

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  Figure 9. The serial changes in blood pressure and pulse pressure. A and B, The comparison of systolic blood pressure and diastolic blood pressure (A), and pulse pressure (B) between before CA, 3 months after CA, and 6 months after CA in patients with recurrence of AF. C and D, The comparison of systolic blood pressure and diastolic blood pressure (C), and pulse pressure (D) between before CA, 3 months after CA, and 6 months after CA in patients without recurrence of AF. E and F, The comparison of systolic blood pressure and diastolic blood pressure (E), and pulse pressure (F) in patients without AF recurrence, all recorded in sinus rhythm (SR) (AF SR group), and normal control subjects. See Figure 3 for the box‐and‐whisker plot, the mean±SD, and the line connecting the mean values. AF indicates atrial fibrillation; CA, catheter ablation; and SR, sinus rhythm.

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  Figure 10. Investigation of the heart rate. A, The comparison of heart rate between in SR or in atrial fibrillation (AF) rhythm at the time of reactive hyperemia‐peripheral arterial tonometry measurement before catheter ablation (CA). B, The comparison of heart rate under AF rhythm at the time of reactive hyperemia‐peripheral arterial tonometry measurement before CA between patients with paroxysmal AF and patients with persistent AF. C, The correlation between heart rate and the natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index. D and E, The comparison of heart rate between before CA, 3 months after CA, and 6 months after CA in patients with recurrence of AF (D) and without recurrence of AF (E). F, The comparison of heart rate between patients without AF recurrence, all recorded in SR (AF SR group), and normal control subjects. See Figure 3 for the box‐and‐whisker plot, the mean±SD, and the line connecting the mean values. AF indicates atrial fibrillation; CA, catheter ablation; LnRHI, natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index; and SR, sinus rhythm.

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  Figure 11. Subanalysis of natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index focused on patients with paroxysmal AF under sinus rhythm and patients with persistent AF under AF rhythm. A, The comparison of the natural logarithmic transformed reactive hyperemia‐peripheral arterial tonometry index (LnRHI) between patients with paroxysmal atrial fibrillation (AF) whose LnRHI were measured under only sinus rhythm (SR) at the time of reactive hyperemia‐peripheral arterial tonometry measurement before catheter ablation (CA) (n=138) and patients with persistent AF whose LnRHI measured under only AF rhythm (n=38). B, The comparison of LnRHI between control patients (n=43), patients with paroxysmal AF under SR(n=138) and patients with persistent AF under AF rhythm (n=38). C through E, The serial changes of the LnRHI in patients with paroxysmal AF under SR (C), patients with persistent AF under AF rhythm (D), and both patients with AF (E). F through H, The serial changes of the LnRHI focused on patients without recurrence in patients with paroxysmal AF under SR (F), patients with persistent AF under AF rhythm (G), and both patients with AF (H). See Figure 3 for the…

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  Figure 12. Re‐analysis of the major findings focused on patients with paroxysmal AF under sinus rhythm and patients with persistent AF under AF rhythm. A and B, The comparison of the LnRHI in patients with (A) and without recurrence of AF (B) focused on patients with paroxysmal AF under SR and patients with persistent AF under AF rhythm. C, Receiver operating characteristic curve analysis focused on patients with paroxysmal AF under SR and patients with persistent AF under AF rhythm. The value of LnRHI 3 months after catheter ablation, which decreased to ≥0.01 compared with that before catheter ablation, was an independent factor of AF recurrence (sensitivity, 0.882; specificity, 0.745; area under the curve, 0.844; P<0.001). D, Kaplan‒Meier analysis focused on patients with paroxysmal AF under SR and patients with persistent AF under AF rhythm. The decrease group in LnRHI 3 months after catheter ablation compared with before catheter ablation (red) had a significantly higher probability of AF recurrence compared with the non‐decrease group (blue) (log‐rank test: P<0.001). See Figure 3 for the box‐and‐whisker plot, the mean±SD, and the line connecting the mean values. AF indicates atrial…