Assessment of autonomic nervous system modulation after novel catheter ablation techniques for atrial fibrillation using multiple short-term electrocardiogram recordings.

Abstract

The effect of novel catheter ablation techniques for atrial fibrillation (AF) on the autonomic nervous system (ANS) is unclear. This study aimed to assess the ANS after three novel catheter ablation techniques for paroxysmal AF by evaluating heart rate variability (HRV) parameters using a 3-min electrocardiogram recording. Two hundred and thirty-five patients who underwent catheter ablation for paroxysmal AF (119 in irrigated-tip, 51 in contact-force sensing-guided, and 65 patients in second-generation cryoballoon ablation) were included. HRV analysis was performed at baseline and 1, 3, 6, and 12months after the ablation. The three ablation groups had similarly decreased HRV parameters after the ablation, and this change was maintained >1year. A reduction in parasympathetic nervous function was more apparent after the ablation, compared to changes in the sympathetic nervous function. Of the total population, 45 patients had recurrence. Ln high frequency (HF) 12months after the ablation was significantly higher in the recurrence group than in the non-recurrence group (1.52±0.47 vs. 1.26±0.57ms2, p=0.007). Multivariate analysis demonstrated that AF duration (hazards ratio 1.09, 95% confidence interval 1.04-1.15, p=0.001) and ln HF 12months after ablation (hazards ratio 1.91, 95% confidence interval 1.12-3.25, p=0.017) were independent predictors of AF recurrence after the ablation. ANS modulation after the three catheter ablation methods was similar and maintained >1year after the procedure. Higher parasympathetic nervous function at 1year after ablation was associated with AF recurrence after the ablation.