Prognosis of high sinus heart rate after catheter ablation for atrial fibrillation.
Aims
Although atrial fibrillation (AF) catheter ablation increases sinus heart rate (HR), its mechanism and prognosis have not yet been clearly elucidated. We hypothesize that post-AF ablation high sinus HR (PA-HSR) is associated with a better clinical outcome of AF ablation without adverse cardiac effects.


Methods and results
We studied 991 AF patients (75% male, 58 ± 11 years old, 70% paroxysmal AF) with HR variability (HRV) at 3 months and 1 year after catheter ablation, and pre- and post-1-year echocardiograms. Post-AF ablation high sinus HR was defined as an average HR greater than 2 SD (≥92 bpm) as measured by 24 h Holter. (1) Average HR increased significantly (P< 0.001), and PA-HSR was observed in 28 patients (2.8%) 3 months after AF ablation. At 1 year after catheter ablation, 21% were taking β-blockers and 36% maintained an average HR of ≥92 bpm. (2) Post-AF ablation high sinus HR was independently associated with pre-procedural high average HR (OR 1.097; 95% CI 1.029-1.169, P= 0.005), high left atrium (LA) electrogram voltage (OR 3.545; 95% CI 1.183-10.618, P= 0.024), and reduced root mean square of differences between successive NN intervals (rMSSD) at 3 months HRV (OR 0.959; 95% CI 0.919-0.999, P= 0.047). (3) At 1 year echocardiography, size reduction of LA (P= 0.055) or LV (P= 0.372) and the improvement in ejection fraction (P= 0.529) were not significantly different between patients with PA-HSR and those without. (4) Throughout 27 ± 17 months of follow-up, patients with PA-HSR showed significantly lower clinical recurrence than those without (log rank, P= 0.020).


Conclusion
Post-AF ablation high sinus HR was observed in patients with smaller LA size and higher LA electrogram voltage and significant vagal modulation without adverse cardiac effects. Post-AF ablation high sinus HR was associated with a significantly lower clinical recurrence of AF after catheter ablation.
['Yu|Hee Tae|HT|', 'Kim|Tae-Hoon|TH|', 'Uhm|Jae-Sun|JS|', 'Kim|Jong-Youn|JY|', 'Joung|Boyoung|B|', 'Lee|Moon-Hyoung|MH|', 'Pak|Hui-Nam|HN|']
D000328:Adult D000368:Aged D000889:Anti-Arrhythmia Agents D001281:Atrial Fibrillation D017115:Catheter Ablation D016009:Chi-Square Distribution D018572:Disease-Free Survival D004452:Echocardiography D015716:Electrocardiography, Ambulatory D022062:Electrophysiologic Techniques, Cardiac D005260:Female D006339:Heart Rate D006801:Humans D053208:Kaplan-Meier Estimate D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D016017:Odds Ratio D057216:Propensity Score D012008:Recurrence D012042:Registries D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D014630:Vagus Nerve
High sinus heart rate Catheter ablation Atrial fibrillation Recurrence