Denervation as a common mechanism underlying different pulmonary vein isolation strategies for paroxysmal atrial fibrillation: evidenced by heart rate variability after ablation

Kejing Wang, Dong Chang, Zhenliang Chu, Yanzong Yang, Lianjun Gao, Shulong Zhang, Yunlong Xia, Yingxue Dong, Xiaomeng Yin, Peixin Cong, Jingjing Jia, Kejing Wang, Dong Chang, Zhenliang Chu, Yanzong Yang, Lianjun Gao, Shulong Zhang, Yunlong Xia, Yingxue Dong, Xiaomeng Yin, Peixin Cong, Jingjing Jia

Abstract

Backgrounds: Segmental and circumferential pulmonary vein isolations (SPVI and CPVI) have been demonstrated to be effective therapies for paroxysmal atrial fibrillation (PAF). PVI is well established as the endpoint of different ablation techniques, whereas it may not completely account for the long-term success.

Methods: 181 drug-refractory symptomatic PAF patients were referred for segmental or circumferential PVI (SPVI = 67; CPVI = 114). Heart rate variability (HRV) was assessed before and after the final ablation.

Results: After following up for 62.23 ± 12.75 months, patients underwent 1.41 ± 0.68 procedures in average, and the success rates in SPVI and CPVI groups were comparable. 119 patients were free from AF recurrence (SPVI-S, n = 43; CPVI-S, n = 76). 56 patients had recurrent episodes (SPVI-R, n = 21; CPVI-R, n = 35). Either ablation technique decreased HRV significantly. Postablation SDNN and rMSSD were significantly lower in SPVI-S and CPVI-S subgroups than in SPVI-R and CPVI-R subgroups (SPVI-S versus SPVI-R: SDNN 91.8 ± 32.6 versus 111.5 ± 36.2 ms, rMSSD 47.4 ± 32.3 versus 55.2 ± 35.2 ms; CPVI-S versus CPVI-R: SDNN 83.0 ± 35.6 versus 101.0 ± 40.7 ms, rMSSD 41.1 ± 22.9 versus 59.2 ± 44.8 ms; all P < 0.05). Attenuation of SDNN and rMSSD remained for 12 months in SPVI-S and CPVI-S subgroups, whereas it recovered earlier in SPVI-R and CPVI-R subgroups. Multivariate logistic regression analysis identified SDNN as the only predictor of long-term success.

Conclusions: Beyond PVI, denervation may be a common mechanism underlying different ablation strategies for PAF.

Figures

Figure 1
Figure 1
Comparison of HRV parameters before and after SPVI. (a) Time-domain parameters of HRV significantly decreased after SPVI in both the success and recurrence subgroups (P < 0.05 versus before ablation). (b) Frequency-domain characteristics of HRV significantly decreased in both the success and recurrence subgroups (P < 0.05 versus pre-ablation). HRV: heart rate variability; SPVI-S: success subgroup for segmental pulmonary vein isolation; SPVI-R: recurrence subgroup for segmental pulmonary vein isolation; CPVI-S: success subgroup for circumferential pulmonary vein isolation; CPVI-R: recurrence subgroup for circumferential pulmonary vein isolation; SDNN: standard deviation of all NN intervals (ms); SDANN, standard deviation of the averages of the NN intervals in all 5-min segments (ms); rMSSD: root mean square root of the differences between adjacent NN intervals (ms); PNN50, percentage of adjacent NN interval differences >50 ms; ULF: ultralow-frequency power; VLF: very-low-frequency power; LF, low-frequency power; HF, high-frequency power. Frequency domain parameters of HRV including TF, ULF, VLF, and LF and HF were logarithmically transformed to normalize the distribution (LnTF, LnULF, LnVLF, LnLF, and LnHF; units: ms2). *P < 0.05.
Figure 2
Figure 2
Comparison of HRV before and after CPVI. (a) Time-domain parameters of HRV significantly decreased after CPVI, both in the success and recurrence subgroups. (b) Frequency-domain characteristics of HRV significantly decreased after CPVI, both in the success and recurrence subgroups. Abbreviations are as in Figure 1. *P < 0.05.
Figure 3
Figure 3
Comparison of postablation HRV between the success and recurrence subgroups. (a) After SPVI or CPVI, SDNN and rMSSD were significantly lower in the success subgroups (SPVI-S and CPVI-S) than in the recurrence subgroups (SPVI-R and CPVI-R). (b) After SPVI or CPVI, there were no significant differences in the frequency-domain parameters of HRV between subgroups (SPVI-S versus SPVI-R; CPVI-S versus CPVI-R, P > 0.05). Abbreviations are as in Figure 1. *P < 0.05.
Figure 4
Figure 4
Serial changes of SDNN and rMSSD during five-year follow-up. (a) SDNN remained attenuated during 12-month follow-up in SPVI-S and CPVI-S subgroups, while recovered after 6 months in SPVI-R and CPVI-R subgroups. (b) rMSSD remained attenuated during 12-month follow-up in SPVI-S and CPVI-S subgroups, while recovered after 1 month in SPVI-R and CPVI-R subgroups. *P < 0.05.
Figure 5
Figure 5
Receiver operator characteristic (ROC) curve indicated the predictive value of SDNN for long-term success of AF ablation. Area under the ROC curve was 0.71. The cut-off value was 91.9, with a sensitivity and specificity of 68.9% and 66.7%.

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Source: PubMed

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