Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

2019 ◽  
Vol 30 (12) ◽  
pp. 2818-2822 ◽  
Author(s):  
Zackary D. Goff ◽  
Balint Laczay ◽  
Gayane Yenokyan ◽  
Bhradeev Sivasambu ◽  
Sunil K. Sinha ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Rate Increase ◽  
Heart Rate Increase

scholarly journals Heart rate increase and inappropriate sinus tachycardia after cryoballoon pulmonary vein isolation for atrial fibrillation

2021 ◽  
Author(s):  
C. van Deutekom ◽  
B. A. Mulder ◽  
H. F. Groenveld ◽  
R. G. Tieleman ◽  
A. C. P. Wiesfeld ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Sinus Tachycardia ◽  
Rate Increase ◽  
Holter Monitoring ◽  
Entire Group ◽  
Inappropriate Sinus Tachycardia ◽  
History Of

Abstract Background Cryoballoon pulmonary vein isolation (PVI) is a common therapy for atrial fibrillation (AF). While moderately increased sinus rhythm heart rate (HR) after PVI has been observed, inappropriate sinus tachycardia (IST) is a rare phenomenon. We aimed to investigate the prevalence and natural history of an abnormal sinus HR response after cryoballoon PVI. Methods We included 169/646 (26.2%) patients with AF undergoing PVI with available Holter recordings before and 3, 6 and 12 months after the procedure. Patients with AF on Holter monitoring were excluded. Mean HR increase ≥ 20 bpm or an IST-like pattern (mean HR > 90 bpm or > 80 bpm when beta-blocking agents were used) following PVI was categorised as abnormal sinus HR response. Results Following PVI, mean HR ± standard deviation increased in the entire group from 63.5 ± 8.4 to 69.1 ± 9.9 bpm at 3 months (p < 0.001), and to 71.9 ± 9.4 bpm at 6 months (p < 0.001). At 12 months, mean HR was 71.2 ± 10.1 bpm (p < 0.001). Only 7/169 patients (4.1%) met criteria for abnormal sinus HR response: mean HR was 61.9 ± 10.6 bpm (pre-ablation), 84.6 ± 9.8 bpm (3 months), 80.1 ± 6.5 bpm (6 months) and 76.3 ± 10.1 bpm (12 months). Even at 12 months, mean HR was significantly different from that pre-ablation in this group (p = 0.033). However, in patients meeting IST-like pattern criteria, mean HR at 12 months was no longer significantly different from that pre-ablation. Conclusion Few patients had an abnormal sinus HR response after PVI. Peak HR was observed 3 months after PVI, but HR was still significantly increased 12 months post-ablation compared with pre-ablation. An IST-like pattern was rarely observed. In these patients, HR decreased to pre-ablation values within a year.

scholarly journals Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

2021 ◽  
Vol 14 (9) ◽  
Author(s):  
Hui-Nam Pak ◽  
Je-Wook Park ◽  
Song-Yi Yang ◽  
Tae-Hoon Kim ◽  
Jae-Sun Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Paroxysmal Atrial Fibrillation ◽  
Antiarrhythmic Drugs ◽  
Procedure Time

Background: The efficacy of cryoballoon pulmonary vein isolation (Cryo-PVI) is equivalent to that of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation (AF). We aimed to compare the efficacy and safety profile of Cryo-PVI and high-power, short-duration (HPSD) radiofrequency catheter ablation (RFCA) in patients with AF. Methods: We prospectively randomized 314 patients with paroxysmal AF (men, 71.3%; 59.9±10.9 years old) to either the Cryo-PVI group (n=156) or HPSD-RFCA group (n=158). Cavotricuspid isthmus ablation and linear ablation from the superior vena cava to the right atrial septum in addition to pulmonary vein isolation were carried out in the majority of patients in the HPSD-RFCA group. The primary end point was AF recurrence after a single procedure; secondary end points were the recurrence pattern, cardioversion rate, follow-up heart rate variability, and response to antiarrhythmic drugs. Results: After a mean follow-up of 9.8±5.1 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank P =0.840). The rate of recurrence as atrial tachycardia ( P >0.999), cardioversion ( P =0.999), and 3-month heart rate variability (high frequency; P =0.506) did not significantly differ. During the final follow-up, sinus rhythm was maintained without antiarrhythmic drugs in 70.5% of the Cryo-PVI group and 73.4% of the HPSD-RFCA group ( P =0.567). No significant difference was found in the major complication rate between the two groups (3.8% versus 0.6%; P =0.066), but total procedure time was significantly shorter in the Cryo-PVI group (78.5±20.2 versus 124.5±37.1 minutes; P <0.001). Conclusions: In patients with paroxysmal AF, the Cryo-PVI is an effective rhythm-control strategy with a shorter procedure time compared with the HPSD-RFCA. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03920917.

Sinus rhythm heart rate increase after atrial fibrillation ablation is associated with lower risk of arrhythmia recurrence

2021 ◽  
Vol 44 (4) ◽  
pp. 651-656
Author(s):  
Ammar M. Killu ◽  
Chance M. Witt ◽  
Alan M. Sugrue ◽  
Vaibhav Vaidya ◽  
Kristi H. Monahan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Lower Risk ◽  
Rate Increase ◽  
Atrial Fibrillation Ablation ◽  
Heart Rate Increase

scholarly journals Changes in heart rate variability in patients with atrial fibrillation after pulmonary vein isolation and ganglionated plexus ablation

2019 ◽  
pp. 49-57 ◽  
Author(s):  
J. Vesela ◽  
P. Osmancik ◽  
D. Herman ◽  
R. Prochazkova
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Low Frequency ◽  
Autonomic System ◽  
Before And After ◽  
Group 5 ◽  
Ganglionated Plexus

Pulmonary vein isolation (PVI) is the cornerstone in the treatment of patients with paroxysmal atrial fibrillation (PAF). Some research has suggested studies have shown that modification of ganglionated plexuses (GP), performed with PVI, could lead to even better outcomes. The aim of this study was to determine the effect of PVI on the autonomic system. Heart rate variability (HRV) was used as a marker of autonomic system activity. Twenty-six PAF patients underwent PVI (PVI group) and twenty patients underwent PVI plus a GP ablation (GP group). In each group, 5 min long ECG signals obtained before and after the electrophysiology EP study were analyzed. Time and frequency domain parameters were evaluated. Vagal responses during ablation were observed in 15 (58 %) patients in the PVI group and in 12 (60 %) patients in the GP group. The change in normalized power in the low frequency (LF) and in the LF/HF ratio, before and after ablation, was statistically significant in both groups (LF/HF 2.6+/-1.6 before vs. 1.4+/-1.7 after ablation in PVI group and LF/HF 3.3+/-2.6 before vs. 1.8+/-1.9 after ablation in the GP group). Relative to heart rate variability parameters, there were no differences between PVI and PVI + plus GP ablation.

scholarly journals Autonomic Alterations After Pulmonary Vein Isolation in the CIRCA‐DOSE (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation) Study

2021 ◽  
Author(s):  
Lisa Y. W. Tang ◽  
Nathaniel M. Hawkins ◽  
Kendall Ho ◽  
Roger Tam ◽  
Marc W. Deyell ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Mean Difference ◽  
Heart Rates ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

Background The natural history of autonomic alterations following catheter ablation of drug‐refractory paroxysmal atrial fibrillation is poorly defined, largely because of the historical reliance on non‐invasive intermittent rhythm monitoring for outcome ascertainment. Methods and Results The study included 346 patients with drug‐refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using contemporary advanced‐generation ablation technologies. All patients underwent insertion of a Reveal LINQ (Medtronic) implantable cardiac monitor before ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (measured as the SD of the average normal‐to‐normal), daytime heart rate, and nighttime heart rate. Longitudinal autonomic data in the 2‐month period leading up to the date of ablation were compared with the period from 91 to 365 days following ablation. Following ablation there was a significant decrease in SD of the average normal‐to‐normal (mean difference versus baseline of 19.3 ms; range, 12.9–25.7; P <0.0001), and significant increases in daytime and nighttime heart rates (mean difference versus baseline of 9.6 bpm; range, 7.4–11.8; P <0.0001, and 7.4 bpm; range, 5.4–9.3; P <0.0001, respectively). Patients free of arrhythmia recurrence had significantly faster daytime (11±11 versus 8±12 bpm, P =0.001) and nighttime heart rates (8±9 versus 6±8 bpm, P =0.049), but no difference in SD of the average normal‐to‐normal ( P =0.09) compared with those with atrial fibrillation recurrence. Ablation technology and cryoablation duration did not influence these autonomic nervous system effects. Conclusions Pulmonary vein isolation results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are correlated with procedural outcome and are independent of the ablation technology used. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01913522.

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