Background

This retrospective observational study investigated the relationship between heart rate variability (HRV) and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) by cryoballoon or radiofrequency ablation (RF).

Methods

We enrolled 497 patients who underwent PVI using first-generation cryoballoon (CB1), second-generation cryoballoon (CB2), or RF. We analyzed HRV as a surrogate for modulation of the intrinsic autonomic nervous system using 24‑h Holter recordings 1 or 2 days after the procedure and compared the recurrence and non-recurrence group with regard to ablation methods. Furthermore, we calculated recurrence-free survival (RFS) below/over HRV cut-off values for the whole study population and separately for each ablation method.

Results

All except one of the five time-based HRV parameters analyzed were significantly lower in the non-recurrence group than in the recurrence group after CB2. Only a trend toward lower HRV for the non-recurrence group was found after RF and no remarkable differences were detected after CB1. The HRV parameters below their calculated cut-off were associated with a significantly higher RFS rate 2 years after CB2. This also applied to root mean sum of squared distance (rMSSD) and the percentage of adjacent NN interval differences greater than 50 ms (pNN50) after RF. No differences were found regarding CB1. Concerning rMSSD, the sensitivity, specificity, and difference in RFS increased when using cut-offs that were calculated including only CB2 patients. Multivariate cox regression analysis showed that low rMSSD values could independently predict AF recurrence after adjusting for covariates (hazard ratio: 0.50; p < 0.001).

Conclusion

Low values of rMSSD early after a PVI could independently predict AF recurrence, especially after CB2.

中文翻译：

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心率变异性作为导管引导肺静脉隔离治疗心房颤动成功的预测因子

背景

这项回顾性观察研究调查了通过冷冻球囊或射频消融 (RF) 进行肺静脉隔离 (PVI) 后心率变异性 (HRV) 与心房颤动 (AF) 复发之间的关系。

方法

我们招募了 497 名使用第一代冷冻球囊 (CB1)、第二代冷冻球囊 (CB2) 或 RF 接受 PVI 的患者。我们在手术后 1 或 2 天使用 24 小时动态心电图记录分析 HRV 作为内在自主神经系统调节的替代指标，并比较复发组和非复发组的消融方法。此外，我们还计算了整个研究人群的无复发生存率 (RFS) 低于/高于 HRV 截止值，并分别针对每种消融方法进行了计算。

结果

CB2 后，除了分析的五个基于时间的 HRV 参数之一外，非复发组的所有参数均显着低于复发组。RF 后仅发现非复发组 HRV 呈较低趋势，CB1 后未检测到显着差异。低于计算截止值的 HRV 参数与 CB2 后 2 年后 RFS 率显着升高相关。这也适用于均方根和距离平方和 (rMSSD) 以及 RF 后大于 50 ms 的相邻 NN 间隔差异的百分比 (pNN50)。CB1 没有发现差异。关于 rMSSD，当使用仅包括 CB2 患者计算的截止值时，RFS 的敏感性、特异性和差异增加。多变量 cox 回归分析显示，调整协变量后，低 rMSSD 值可以独立预测 AF 复发（风险比：0.50；p  < 0.001）。

结论

PVI 后早期 rMSSD 的低值可以独立预测 AF 复发，尤其是 CB2 后。