Abstract
How deceleration capacity (DC) and acceleration capacity (AC) of heart rate associated with atrial fibrillation (AF) and ablation is still not clear. The dynamic changes of AC, DC and conventional heart rate variability (HRV) parameters were characterized in 154 subjects before circumferential pulmonary veins isolation (CPVI) and three days, 3 months and 6 months after CPVI. The DCs of the recurrent group decreased significantly at each time point after CPVI; the DCs of the recurrence-free group before CPVI and three days, 3 months and 6 months after CPVI were 7.06 ± 1.77, 3.79 ± 1.18, 4.22 ± 1.96 and 3.97 ± 0.98 ms respectively, which also decreased significantly at each time point and were significantly lower than these of recurrent group. Conversely, the AC of recurrent and recurrence-free groups increased significantly at each time point after CPVI; the ACs of recurrence-fee group were significantly higher than these of recurrent group at each time point. No stable difference trend of HRV parameters was found between two groups. Further Kaplan–Meier analysis showed that DC < 4.8 ms or AC ≥ −5.1 ms displayed significant higher recurrence-free rates. In conclusion, high AC and low DC imply higher AF-free rate after ablation.
Highlights
The heart is richly innervated by the sympathetic and parasympathetic nerves[1,2,3]
The deceleration capacity (DC) of the recurrence-free group before circumferential pulmonary veins isolation (CPVI) and three days, 3 months and 6 months after CPVI were 7.06 ± 1.77, 3.79 ± 1.18, 4.22 ± 1.96 and 3.97 ± 0.98 ms respectively; the DC decreased significantly three days after CPVI and kept at relatively low level through out 6 months; impressively, the DCs were significantly lower in recurrence-free group than these in recurrent group at each time point (Fig. 2A)
Ablation significantly reduced the DCs both in recurrent and recurrence-free groups; the mean DC of recurrent group had recovered significantly 3 and 6 months after ablation; the mean DC of recurrence-free group kept at a relative low level through out the 6 months; the mean DCs were significantly lower in recurrence-free group than these in recurrent group at each time point
Summary
The heart is richly innervated by the sympathetic and parasympathetic (vagal) nerves[1,2,3]. The overall role of sympathetic nerves in the heart is to modulate the automaticity of sinoatrial node and the conductivity of atrioventricular node[1,2,3]. In 2006, Baver et al created a series of signal processing technology and algorithm to separately characterize the deceleration and acceleration capacities of the heart rate using 24-h ambulatory electrocardiogram[15]. Their calculation principle and later reports suggested that AC and DC might distinguish and quantify between vagal and sympathetic nervous system roles that affect cardiac electrophysiology[15,16,17]. The dynamic change trend of AC and DC before and after CPVI was compared between recurrent and recurrence-free subjects
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