Department of Cardiology, Grochowski Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Cardiology, Grochowski Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
Kardiol Pol. 2019 Oct 25;77(10):960-965. doi: 10.33963/KP.14950. Epub 2019 Aug 28.
Pulmonary vein isolation (PVI) is a well‑established treatment method in patients with paroxysmal atrial fibrillation (AF). However, the predictors of a successful outcome are less well known. It has been suggested that PVI‑induced changes in autonomic control of sinus rate (SR) may correspond to ablation efficacy.
We aimed to assess whether PVI‑induced changes in SR may help identify responders to PVI.
The study group consisted of 111 consecutive patients (mean [SD] age, 55 [10] years; 81 men) who underwent the first ablation of paroxysmal AF (radiofrequency [RF] ablation, 56 patients; cryoballoon [CB] ablation, 55 patients). The SR was calculated from a standard 12‑lead electrocardiogram recorded a day before and 2 days after ablation. Patients were followed for 1 year on an outpatient basis and underwent serial 4- to 7‑day Holter electrocardiogram recordings at 3, 6, and 12 months after ablation.
Ablation was effective in 74 patients (67%). Univariate and multivariate analyses showed that younger age, faster SR, and a greater increase in SR (ΔSR) after ablation were significantly associated with successful outcome. The results were similar between patients who underwent RF and CB ablation. The sensitivity, specificity, negative predictive value, and positive predictive value of ΔSR higher than 15 bpm for the identification of responders were 53%, 73%, 80%, and 44%, respectively.
Acceleration of SR following ablation for paroxysmal AF may serve as an additional simple clinical parameter that may improve the prediction of outcome after PVI.
肺静脉隔离（PVI）是阵发性心房颤动（AF）患者的一种成熟的治疗方法。然而，成功治疗的预测因素知之甚少。有人认为，PVI 诱导的窦性心率（SR）自主神经控制变化可能与消融效果相对应。
我们旨在评估 SR 的 PVI 诱导变化是否有助于识别 PVI 的应答者。
研究组包括 111 例连续接受阵发性 AF 首次消融的患者（平均[标准差]年龄，55[10]岁；81 例男性）（射频[RF]消融 56 例，冷冻球囊[CB]消融 55 例）。SR 是从消融前 1 天和 2 天后记录的标准 12 导联心电图计算得出的。患者在门诊接受 1 年随访，并在消融后 3、6 和 12 个月进行连续 4 至 7 天的 Holter 心电图记录。
消融在 74 例患者（67%）中有效。单因素和多因素分析表明，年龄较小、SR 较快以及消融后 SR 增加（ΔSR）较大与治疗效果显著相关。RF 和 CB 消融患者的结果相似。ΔSR 高于 15 bpm 对识别应答者的敏感性、特异性、阴性预测值和阳性预测值分别为 53%、73%、80%和 44%。
阵发性 AF 消融后 SR 的加速可能作为一种额外的简单临床参数，可提高 PVI 后结果预测的准确性。
