Feasibility of multiple short, 40-s, intra-procedural ECG recordings to detect immediate changes in heart rate variability during catheter ablation for arrhythmias

Phang Boon Lim, Louisa C Malcolme-Lawes, Thomas Stuber, Michael Koa-Wing, Ian J Wright, Therese Tillin, Richard Sutton, D Wyn Davies, Nicholas S Peters, Darrel P Francis, Prapa Kanagaratnam, Phang Boon Lim, Louisa C Malcolme-Lawes, Thomas Stuber, Michael Koa-Wing, Ian J Wright, Therese Tillin, Richard Sutton, D Wyn Davies, Nicholas S Peters, Darrel P Francis, Prapa Kanagaratnam

Abstract

Purpose: This study aims to evaluate a method to detect heart rate variability (HRV) changes using short ECG segments during ablation for arrhythmias.

Methods: HRV was averaged from sequentially shorter time windows from 5-min ECG recordings in 15 healthy volunteers. The 40-s window was identified as the shortest duration that yielded reproducible values in high frequency (HF) and low frequency (LF) HRV. This method was validated in patients undergoing tilt table testing to see if the expected modulation in HRV that occurs prior to syncope could be detected from multiple 40-s recordings. Lastly, this method was used to assess HRV changes in 75 patients undergoing ablation for atrial fibrillation (AF) and other arrhythmias, to see if autonomic modulation as a result of ablation could be detected. A further 14 patients had stepwise HRV measurements at different stages of the AF ablation procedure to determine whether intra-procedural HRV changes could be detected.

Results: HRV, averaged from multiple 40-s recordings, demonstrated the expected increase immediately preceding syncope compared with baseline (LF: 341 ± 311-1,536 ± 1,368 ms(2), p< 0.05; HF: 342 ± 339-1,628 ± 1,755 ms(2), p < 0.05). AF ablation, particularly following right pulmonary vein circumferential ablation, produced immediately detectable reductions in LF (153 ± 251-50 + 116 ms(2), p < 0.001) and HF (86 ± 195-33 ± 83 ms(2), p < 0.001) without any change in RR interval (877 ± 191-843 ± 220 ms, p = 0.261). Ablation for atrial flutter did not change the mean RR interval, LF or HF HRV.

Conclusion: Averaging multiple 40-s windows give valid HF and LF HRV measurements that enable detection of intra-procedural changes. Left atrial ablation around the right-sided pulmonary veins is unique in producing reductions in HRV. This method has the potential for use as an endpoint marker for adjunctive autonomic ablation procedures.

Figures

Fig. 1
Fig. 1
Validation of short recording duration for HRV calculation. Log HF (a) and log LF (b) values plotted against duration of analysis in 15 healthy volunteers. The HF power showed no shift in mean value in all recording durations, although scatter increased at 30 and 20 s recording durations. The LF power showed no shift in mean value down to 40 s. However, at window durations shorter than 40 s, there was a significant difference (p < 0.05), and increased scatter in the mean LF values. Mean HRV indices for each recording duration compared by one-way ANOVA with Newman–Keuls correction for comparison between the means. HF high frequency, LF low frequency, HRV heart rate variability
Fig. 2
Fig. 2
Changes in RR interval and HRV indices after ablation. Non-AF includes patients having ablation for atrial flutter, atrioventricular nodal re-entry tachycardia, atrioventricular re-entrant tachycardia and negative electrophysiological studies. NS nonsignfiiciant
Fig. 3
Fig. 3
Power spectral density and RR tachogram plots pre- and post-ablation power spectral density and RR tachogram plots for example patients in AF and atrial flutter
Fig. 4
Fig. 4
Changes in HRV indices measured in a step-wise fashion Step-wise HRV changes in 14 patients. Seven patients had left before right pulmonary vein ablation and seven patients had right before left pulmonary vein wide area circumferential ablation. LF and HF HRV indices were measured in a step-wise fashion at each stage of the procedure, including: baseline, after transseptal puncture, after left-sided circumferential PV isolation and after right-sided circumferential PV isolation. HF high frequency, LF low frequency, HRV heart rate variability, PV pulmonary veins

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Source: PubMed

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