Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Ann Noninvasive Electrocardiol. 2023 Sep;28(5):e13074. doi: 10.1111/anec.13074. Epub 2023 Jul 19.
Pulmonary vein isolation (PVI) is a cornerstone therapy for paroxysmal atrial fibrillation (PAF). The variations in nonlinear heart rate variability (HRV) between patients with and without recurrences remain unclear. We aimed to characterize the nonlinear HRV before and after PVI in patients with and without recurrence.
Twenty-five drug-refractory PAF patients (56.0 ± 9.1 years old, 20 males) who received PVI were enrolled. Holter electrocardiography were performed before, 1-3, and 6-12 months after PVI. After 8.2 ± 2.5 months of follow-ups after PVI, patients were divided into two groups: the recurrence (n = 8) and non-recurrence (n = 17) groups. Linear and nonlinear HRV variables were analyzed, including the Poincaré Plot analysis and the Detrended Fluctuation Analysis (DFA).
The non-recurrence group, but not the recurrence group, had decreased high-frequency component (HF), the root mean square of successive RR interval differences (RMSSD), and the Poincaré Plot index SD1 1-3 months after PVI and increased DFA 6-12 months after PVI. The non-recurrence group's LF/HF ratio and DFA decreased significantly 1-3 and 6-12 months after PVI, respectively, whereas there was no significant change in the recurrence group after PVI.
Significantly reduced vagal tone 1-3 months after PVI, increased long-term fractal complexity 6-12 months after PVI, and decreased sympathetic tone as well as short-term fractal complexity 1-3 and 6-12 months after PVI led to a better AF-free survival after PVI. These findings suggest that neuromodulation and heart rate dynamics play crucial roles in AF recurrence following PVI.
肺静脉隔离（PVI）是阵发性心房颤动（PAF）的基石疗法。有复发和无复发患者之间的心率变异性（HRV）非线性变化尚不清楚。我们旨在描述 PVI 前后有复发和无复发患者的非线性 HRV。
我们招募了 25 例药物难治性 PAF 患者（56.0±9.1 岁，男性 20 例），他们接受了 PVI。在 PVI 前、1-3 个月和 6-12 个月后进行 Holter 心电图检查。在 PVI 后 8.2±2.5 个月的随访后，患者分为两组：复发组（n=8）和非复发组（n=17）。分析线性和非线性 HRV 变量，包括 Poincaré 图分析和去趋势波动分析（DFA）。
非复发组而非复发组在 PVI 后 1-3 个月时 HF、连续 RR 间期差异的均方根（RMSSD）和 Poincaré 图指数 SD1 降低，而 DFA 在 PVI 后 6-12 个月时增加。非复发组 LF/HF 比值和 DFA 在 PVI 后 1-3 和 6-12 个月时分别显著降低，而复发组在 PVI 后无明显变化。
PVI 后 1-3 个月迷走神经张力明显降低，6-12 个月后长期分形复杂度增加，以及 PVI 后 1-3 和 6-12 个月时交感神经张力和短期分形复杂度降低，导致 PVI 后 AF 无复发生存率提高。这些发现表明，神经调节和心率动力学在 PVI 后 AF 复发中起着关键作用。
