Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Mayo Medical School, Rochester, Minnesota, USA.
Pacing Clin Electrophysiol. 2021 Apr;44(4):651-656. doi: 10.1111/pace.14197. Epub 2021 Feb 25.
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.
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.
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.
Relative changes in HR post AF ablation correlates with AF recurrence. Further prospective studies are needed to confirm this relationship.
与单纯肺静脉隔离（PVI）相比，自主神经调节下的 PVI 可能更有助于房颤（AF）消融，且消融后窦性心律心率（HR）的变化可能提示这一点。我们旨在确定窦性心律 HR 的变化是否可预测 PVI 后 AF 复发。
纳入 2000 年至 2011 年接受 AF 消融的患者，要求在消融前 90 天内和消融后 7 天内心电图记录窦性心律。分析基本心电图间期和 HR 变化，并确定结果。
共纳入 1152 例患者（74.3%为男性，平均年龄 57 ± 11 岁）。AF 平均持续时间为 5.2 ± 5.3 年。1152 例患者中，712 例（61.8%）为阵发性 AF。平均 EF 为 61% ± 6%。消融前窦性心律 HR 为 61 ± 11bpm，消融后为 76 ± 13bpm（增加 27% ± 24%，p < 0.001）。消融后相对 HR 变化预测 AF 复发的能力呈临界（危险比 0.65 [0.41-1.01]，p = 0.067）。根据相对 HR 变化将患者分为四组，多变量模型分析显示 HR 相对增加最多的上四分位组与最低四分位组相比，AF 复发率显著降低（p = 0.038）。PR 间期（171 ± 28 至 167 ± 30ms）和 QTc 间期（424 ± 25 至 434 ± 29ms）均有显著变化（均 p < 0.001），但这些变化与结局无关。
AF 消融后 HR 的相对变化与 AF 复发相关。需要进一步前瞻性研究来证实这种关系。
