Acceleration of sinus rhythm following ablation for atrial fibrillation: a simple parameter predicting ablation efficacy

Abstract

Background: Pulmonary vein isolation (PVI) is a well‑established treatment method in patients with paroxysmal atrial fibrillation (AF). However, the predictors of a successful outcome are less well known. It has been suggested that PVI‑induced changes in autonomic control of sinus rate (SR) may correspond to ablation efficacy.

Aims: We aimed to assess whether PVI‑induced changes in SR may help identify responders to PVI.

Methods: The study group consisted of 111 consecutive patients (mean [SD] age, 55 [10] years; 81 men) who underwent the first ablation of paroxysmal AF (radiofrequency [RF] ablation, 56 patients; cryoballoon [CB] ablation, 55 patients). The SR was calculated from a standard 12‑lead electrocardiogram recorded a day before and 2 days after ablation. Patients were followed for 1 year on an outpatient basis and underwent serial 4- to 7‑day Holter electrocardiogram recordings at 3, 6, and 12 months after ablation.

Results: Ablation was effective in 74 patients (67%). Univariate and multivariate analyses showed that younger age, faster SR, and a greater increase in SR (ΔSR) after ablation were significantly associated with successful outcome. The results were similar between patients who underwent RF and CB ablation. The sensitivity, specificity, negative predictive value, and positive predictive value of ΔSR higher than 15 bpm for the identification of responders were 53%, 73%, 80%, and 44%, respectively.

Conclusions: Acceleration of SR following ablation for paroxysmal AF may serve as an additional simple clinical parameter that may improve the prediction of outcome after PVI.