Abstract 17846: Prognosis of High Sinus Heart Rate After Catheter Ablation for Atrial Fibrillation

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Introduction: Although radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) increases a sinus heart rate (HR) after rhythm control, its mechanism and prognosis have not yet been clearly elucidated. Hypothesis: We hypothesized that post-procedural high sinus HR is associated with better clinical outcome of AF ablation without hemodynamic adverse effects. Methods: We included 991 AF patients (75% male, 58 ± 11 years old, 70% paroxysmal AF [PAF]) who had analyzable HR variability (HRV) at 3-months and 1-year after RFCA, and pre- and post-1-year echocardiogram. Average HR measured by 24-hour Holter greater than 2SD (≥92bpm) was defined as post-ablation high sinus HR. Results: 1. Average heart rate was increased significantly (68.8±13.1 to 71.4±10.7bpm, p<0.001), and high sinus HR (≥92bpm) was observed in 28 patients (2.8%) at 3-months after AF ablation. All of them tolerated well, 21% (6/28) were taking low dose β-blocker, and 36% (10/28) kept average HR≥92bpm at 1-year after RFCA. 2. High sinus HR was independently associated with pre-procedural high average HR (OR 1.097; 95% CI 1.029 to 1.169, p=0.005), high left atrial (LA) voltage (OR 3.545; 95% CI 1.183 to 10.618, p=0.024), and reduced rMSSD at 3-months HRV (OR 0.959; 95% CI 0.919 to 0.999, p=0.047). 3. At 1-year follow-up echocardiogram, LA reverse remodeling (ΔLA; -1.1±3.7 vs. -3.0±4.6mm, p=0.055) and the improvement of ejection fraction (ΔEF; 0.7±8.4 vs. 1.7±7.7%, p=0.529) were not significantly different between the patients with high sinus HR and those without. 4. During 27±17 months of follow-up, the patients with high sinus HR at 3-months after RFCA showed significantly lower clinical recurrence than those without (log rank, p=0.020). Conclusions: High sinus HR 3-months after AF ablation is observed in patients with less remodeled LA with significant post-procedure vagal modulation. High sinus HR after AF ablation did not show hemodynamic adverse effect and was associated with lower clinical recurrence rate of AF after RFCA.