Vassallo Fabricio, Corcino Lucas, Cunha Christiano, Serpa Eduardo, Lovatto Carlos, Simoes Aloyr, Carloni Hermes, Hespanhol Dalton, Gasparini Dalbian, Barbosa Luiz Fernando, Schmidt Andre
School of Medicine, Hospital Santa Casa Misericordia Vitoria, Dr. Joao Dos Santos Neves St, 143, Vila Rubim, Vitoria, Espirito Santo, 29025-023, Brazil.
Internal Medicine Department of Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, Brazil.
J Interv Card Electrophysiol. 2025 Mar;68(2):371-377. doi: 10.1007/s10840-023-01653-2. Epub 2023 Sep 29.
There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration (HPSD) incidental parasympathetic denervation during AF ablation predicts long term success. Between December 2018 and December 2021, prospectively enrolled 214 patients who presented in sinus rhythm at AF ablation. Used 50 W of power and contact force (CF) of 5-15 g and 10-20 g at a flow rate of 40 mL/min on the anterior and posterior left atrial walls, respectively.
Males were 143 (66.8%) and paroxysmal was 124 (57.9%) patients. Mean age 61.1 ± 12.3 years and follow-up time was 32.8 ± 13.2 months. Arrhythmia occurred after 90 days in 39 (18.2%) patients, 19 (48.7%) from the paroxysmal and 20 (51.3%) from the persistent AF patients. Recurrence group showed a lower HRI from a mean of 57 ± 7.7 to 64.4 ± 10.4 bpm (12.3%) while in success group HRI was from 53.8 ± 9.7 to 66.8 ± 11.6 bpm [(24.2%) p = 0.04]. We divided HRI in 3 percentiles of ≤ 8%, > 8 ≤ 37% and > 37%. A predictor of recurrence was identified in those in the first (< 8%, p = 0.006) and a predictor of success in the later (> 37%, p = 0.01) HRI percentile.
Atrial fibrillation ablation with HPSD incidental cardiac parasympathetic denervation identified that patients with lower heart rate increase are prone to recurrence while those with higher heart rate increase had higher maintenance of sinus rhythm at a long-term follow-up.
在消融术后房颤复发的技术和基质方面存在多种因素。我们试图研究房颤消融期间并发高功率短持续时间（HPSD）意外性副交感神经去神经支配所导致的心率增加程度（HRI）是否能预测长期成功率。在2018年12月至2021年12月期间，前瞻性纳入了214例在房颤消融时呈窦性心律的患者。分别在左心房前壁和后壁以40 mL/min的流速使用50 W功率和5 - 15 g及10 - 20 g的接触力（CF）。
男性患者143例（66.8%），阵发性房颤患者124例（57.9%）。平均年龄61.1±12.3岁，随访时间32.8±13.2个月。39例（18.2%）患者在90天后出现心律失常，其中阵发性房颤患者19例（48.7%），持续性房颤患者20例（51.3%）。复发组的HRI从平均57±7.7次/分降至64.4±10.4次/分（12.3%），而成功组的HRI从53.8±9.7次/分升至66.8±11.6次/分[（24.2%），p = 0.04]。我们将HRI分为≤8%、>8%≤37%和>37%三个百分位数。在第一个百分位数（<8%，p = 0.006）中发现了复发的预测因素，在较高的（>37%，p = 0.01）HRI百分位数中发现了成功的预测因素。
伴有HPSD意外性心脏副交感神经去神经支配的房颤消融表明，心率增加较低的患者易于复发，而心率增加较高的患者在长期随访中窦性心律维持率较高。
