Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

Zackary D. Goff, Balint Laczay, Gayane Yenokyan, Bhradeev Sivasambu, Sunil K. Sinha, Joseph E. Marine, Hiroshi Ashikaga, Ron D. Berger, David D. Spragg, Hugh Calkins, Tauseef Akhtar

Research output: Contribution to journalArticle

Abstract

Introduction: Ablation of atrial vagal ganglia has been associated with improved pulmonary vein isolation (PVI) outcomes. Disruption of vagal reflexes results in heart rate (HR) increase. We investigated the association between HR change after PVI and freedom from atrial fibrillation (AF) at 1 year. Methods and Results: Patients who underwent PVI for paroxysmal AF were identified from the Johns Hopkins Hospital AF registry. Electrocardiograms taken pre-PVI and post-PVI were used to determine the change in HR. Patients followed-up at 3, 6, and 12 months. Of 257 patients (66% male, age 59+/-11 years), 134 (52%) remained free from AF at 1 year. The average HR increased from 60.6 ± 11.3 beats per minute (bpm) pre-PVI to 70.7 ± 12.0 bpm post-PVI. Patients with recurrence of AF had lower post-PVI HR than those who remained free from AF (67.8 ± 0.2 vs 73.3 ± 13.0 bpm; P <.001). The probability of AF recurrence at 1-year decreased as the change in HR increased (estimated odds ratio [OR], 0.83; 95% confidence interval [CI, 0.74-0.93]; P =.002). HR increase more than 15 bpm was associated with the lowest odds of AF recurrence (estimated OR, 0.39; 95% [0.17-0.85]; P =.018) compared to HR decrease. Conclusions: Resting HR was found to increase after PVI. Increase in HR more than 15 bpm has a positive association with remaining free from atrial fibrillation at 1 year.

Original languageEnglish (US)
JournalJournal of cardiovascular electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

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Pulmonary Veins
Atrial Fibrillation
Heart Rate
Recurrence
Odds Ratio
Ganglia
Reflex
Registries
Electrocardiography
Confidence Intervals

Keywords

  • ablation
  • atrial fibrillation
  • heart rate increase
  • pulmonary vein isolation
  • vagal ganglia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{544176ef74eb45c6b5df1d75fbf06105,
title = "Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year",
abstract = "Introduction: Ablation of atrial vagal ganglia has been associated with improved pulmonary vein isolation (PVI) outcomes. Disruption of vagal reflexes results in heart rate (HR) increase. We investigated the association between HR change after PVI and freedom from atrial fibrillation (AF) at 1 year. Methods and Results: Patients who underwent PVI for paroxysmal AF were identified from the Johns Hopkins Hospital AF registry. Electrocardiograms taken pre-PVI and post-PVI were used to determine the change in HR. Patients followed-up at 3, 6, and 12 months. Of 257 patients (66{\%} male, age 59+/-11 years), 134 (52{\%}) remained free from AF at 1 year. The average HR increased from 60.6 ± 11.3 beats per minute (bpm) pre-PVI to 70.7 ± 12.0 bpm post-PVI. Patients with recurrence of AF had lower post-PVI HR than those who remained free from AF (67.8 ± 0.2 vs 73.3 ± 13.0 bpm; P <.001). The probability of AF recurrence at 1-year decreased as the change in HR increased (estimated odds ratio [OR], 0.83; 95{\%} confidence interval [CI, 0.74-0.93]; P =.002). HR increase more than 15 bpm was associated with the lowest odds of AF recurrence (estimated OR, 0.39; 95{\%} [0.17-0.85]; P =.018) compared to HR decrease. Conclusions: Resting HR was found to increase after PVI. Increase in HR more than 15 bpm has a positive association with remaining free from atrial fibrillation at 1 year.",
keywords = "ablation, atrial fibrillation, heart rate increase, pulmonary vein isolation, vagal ganglia",
author = "Goff, {Zackary D.} and Balint Laczay and Gayane Yenokyan and Bhradeev Sivasambu and Sinha, {Sunil K.} and Marine, {Joseph E.} and Hiroshi Ashikaga and Berger, {Ron D.} and Spragg, {David D.} and Hugh Calkins and Tauseef Akhtar",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jce.14257",
language = "English (US)",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
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TY - JOUR

T1 - Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

AU - Goff, Zackary D.

AU - Laczay, Balint

AU - Yenokyan, Gayane

AU - Sivasambu, Bhradeev

AU - Sinha, Sunil K.

AU - Marine, Joseph E.

AU - Ashikaga, Hiroshi

AU - Berger, Ron D.

AU - Spragg, David D.

AU - Calkins, Hugh

AU - Akhtar, Tauseef

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Ablation of atrial vagal ganglia has been associated with improved pulmonary vein isolation (PVI) outcomes. Disruption of vagal reflexes results in heart rate (HR) increase. We investigated the association between HR change after PVI and freedom from atrial fibrillation (AF) at 1 year. Methods and Results: Patients who underwent PVI for paroxysmal AF were identified from the Johns Hopkins Hospital AF registry. Electrocardiograms taken pre-PVI and post-PVI were used to determine the change in HR. Patients followed-up at 3, 6, and 12 months. Of 257 patients (66% male, age 59+/-11 years), 134 (52%) remained free from AF at 1 year. The average HR increased from 60.6 ± 11.3 beats per minute (bpm) pre-PVI to 70.7 ± 12.0 bpm post-PVI. Patients with recurrence of AF had lower post-PVI HR than those who remained free from AF (67.8 ± 0.2 vs 73.3 ± 13.0 bpm; P <.001). The probability of AF recurrence at 1-year decreased as the change in HR increased (estimated odds ratio [OR], 0.83; 95% confidence interval [CI, 0.74-0.93]; P =.002). HR increase more than 15 bpm was associated with the lowest odds of AF recurrence (estimated OR, 0.39; 95% [0.17-0.85]; P =.018) compared to HR decrease. Conclusions: Resting HR was found to increase after PVI. Increase in HR more than 15 bpm has a positive association with remaining free from atrial fibrillation at 1 year.

AB - Introduction: Ablation of atrial vagal ganglia has been associated with improved pulmonary vein isolation (PVI) outcomes. Disruption of vagal reflexes results in heart rate (HR) increase. We investigated the association between HR change after PVI and freedom from atrial fibrillation (AF) at 1 year. Methods and Results: Patients who underwent PVI for paroxysmal AF were identified from the Johns Hopkins Hospital AF registry. Electrocardiograms taken pre-PVI and post-PVI were used to determine the change in HR. Patients followed-up at 3, 6, and 12 months. Of 257 patients (66% male, age 59+/-11 years), 134 (52%) remained free from AF at 1 year. The average HR increased from 60.6 ± 11.3 beats per minute (bpm) pre-PVI to 70.7 ± 12.0 bpm post-PVI. Patients with recurrence of AF had lower post-PVI HR than those who remained free from AF (67.8 ± 0.2 vs 73.3 ± 13.0 bpm; P <.001). The probability of AF recurrence at 1-year decreased as the change in HR increased (estimated odds ratio [OR], 0.83; 95% confidence interval [CI, 0.74-0.93]; P =.002). HR increase more than 15 bpm was associated with the lowest odds of AF recurrence (estimated OR, 0.39; 95% [0.17-0.85]; P =.018) compared to HR decrease. Conclusions: Resting HR was found to increase after PVI. Increase in HR more than 15 bpm has a positive association with remaining free from atrial fibrillation at 1 year.

KW - ablation

KW - atrial fibrillation

KW - heart rate increase

KW - pulmonary vein isolation

KW - vagal ganglia

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U2 - 10.1111/jce.14257

DO - 10.1111/jce.14257

M3 - Article

C2 - 31670430

AN - SCOPUS:85074825257

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

ER -