Department of Cardiology, Karolinska University Hospital, S1:02, 17176, Solna, Stockholm, Sweden.
Clin Res Cardiol. 2021 Jun;110(6):851-860. doi: 10.1007/s00392-020-01765-z. Epub 2020 Nov 12.
Cather ablation is known to influence the autonomic nervous system. This study sought to investigate the association of sinus heart rate pre-/post-ablation and recurrences in patients with atrial fibrillation undergoing pulmonary vein isolation (PVI).
Between January 2012 and December 2017, data of 482 patients undergoing their first PVI were included. Sinus heart rate was recorded before (PRE), directly post-ablation (POST) and 3 months post-ablation (3 M). All patients were screened for atrial tachyarrhythmia recurrences during the one-year follow-up.
In the total study cohort, 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 3 M [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 POST and 3 M (both p < 0.001 compared to PRE). However, at 3 M the mean sinus heart rate was significantly lower in patients with compared to patients without recurrences (p = 0.031). In this regard, patients with a heart rate change < 11 bpm (PRE to 3 M) or, as an alternative parameter, patients with a heart rate < 60 bpm at 3 M had a significantly higher risk of recurrences compared to the remaining patients (Hazard ratio (HR) 1.82 (95% CI 1.32-2.49), p < 0.001 and HR 1.64 (95% CI 1.20-2.25), p = 0.002, respectively).
Our study confirms the impact of PVI on cardiac autonomic function with a significant sinus heart rate increase post-ablation. Patients with a sinus heart rate change < 11 bpm (PRE to 3 M) are at higher risk for recurrences during one-year post-PVI.
已知导管消融会影响自主神经系统。本研究旨在探讨心房颤动患者行肺静脉隔离（PVI）术后窦性心率在消融前/后与复发之间的关系。
2012 年 1 月至 2017 年 12 月，共纳入 482 例行首次 PVI 的患者。在术前（PRE）、直接术后（POST）和术后 3 个月（3M）记录窦性心率。所有患者在 1 年随访期间均筛查房性心动过速复发情况。
在整个研究队列中，PRE 时的静息窦性心率平均值为 57.9bpm（95%CI 57.1-58.7bpm），POST 时增加超过 10bpm，达到 69.4bpm（95%CI 68.5-70.3bpm）；p<0.001），在 3M 时略有下降[平均 67.3bpm（95%CI 66.4-68.2bpm）]，但仍高于 PRE（p<0.001）。这种模式在 POST 和 3M 时有和没有复发的患者中均可见（与 PRE 相比均 p<0.001）。然而，在 3M 时，与无复发患者相比，有复发患者的平均窦性心率明显较低（p=0.031）。在这方面，与其余患者相比，心率变化<11bpm（PRE 至 3M）的患者或替代参数 3M 时心率<60bpm 的患者复发风险显著更高（风险比（HR）1.82（95%CI 1.32-2.49），p<0.001 和 HR 1.64（95%CI 1.20-2.25），p=0.002）。
本研究证实了 PVI 对心脏自主功能的影响，消融后窦性心率显著增加。在 PVI 后 1 年内，心率变化<11bpm（PRE 至 3M）的患者复发风险更高。
