Sinus heart rate post pulmonary vein ablation and long-term risk of recurrences
Abstract Aim To investigate the association of sinus heart rate pre- and post-ablation and recurrence rates in patients undergoing catheter ablation for atrial fibrillation. Methods Between January 2012 and December 2017, data of 482 patients undergoing their first pulmonary vein isolation (PVI) were included. All patients were followed-up for 12 months and were screened for any atrial tachyarrhythmia. Sinus heart rate measurements were recorded before (PRE), directly post ablation (POST) and 3 months post ablation (3M). Results In the total study population, the mean resting sinus heart rate at PRE (mean 57.9 bpm (95% CI, 57.1–58.7 bpm)) increased by over 10 bpm to POST (mean 69.4 bpm (95% CI, 68.5–70.3 bpm); p<0.001) followed by a slight decrease at 3M (mean 67.3 bpm (95% CI, 66.4–68.2 bpm)) but still remaining higher compared to PRE (p<0.001). This pattern was observed in patients with and without recurrences at PRE, POST and 3M respectively (both p<0.001). However, only at 3M, there was a significant difference in mean heart rate being lower in patients with compared to patients without recurrences (p=0.031). In this regard, patients with a heart rate ≥60 bpm at 3M and a heart rate change ≥11 bpm (PRE to 3M) had a favorable outcome in terms of recurrences compared to the remaining patients (HR 0.61 (95% CI, 0.44–0.84), p=0.002 and HR 0.55 (95% CI, 0.40–0.76), p<0.001, respectively). These variables remained independently associated in multivariable analysis. Conclusion Our study confirms the impact of PVI on cardiac autonomic function with a significant heart increase post-ablation. A heart rate ≥60bpm at 3M and a heart rate change ≥11 bpm (PRE to 3M) are associated with a favorable outcome in terms of recurrences. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): German Research Foundation