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Sinus rhythm heart rate increase after atrial fibrillation ablation is associated with lower risk of arrhythmia recurrence
Author(s) -
Killu Ammar M.,
Witt Chance M.,
Sugrue Alan M.,
Vaidya Vaibhav,
Monahan Kristi H.,
Barnes Stephanie,
Lenz Charles J.,
Yogeswaran Vidhushei,
Sun Philip Y.,
Hodge David O.,
Friedman Paul A.,
Packer Douglas L.,
Asirvatham Samuel J.
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14197
Subject(s) - medicine , atrial fibrillation , cardiology , ablation , sinus rhythm , hazard ratio , quartile , pulmonary vein , catheter ablation , prospective cohort study , heart rate , proportional hazards model , confidence interval , blood pressure
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.