Heart rate increase and inappropriate sinus tachycardia after cryoballoon pulmonary vein isolation for atrial fibrillation

C. van Deutekom, B. A. Mulder*, H. F. Groenveld, R. G. Tieleman, A. C. P. Wiesfeld, E. S. Tan, I. C. van Gelder, M. Rienstra, Y. Blaauw

*Corresponding author for this work

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Abstract

Background: Cryoballoon pulmonary vein isolation (PVI) is a common therapy for atrial fibrillation (AF). While moderately increased sinus rhythm heart rate (HR) after PVI has been observed, inappropriate sinus tachycardia (IST) is a rare phenomenon. We aimed to investigate the prevalence and natural history of an abnormal sinus HR response after cryoballoon PVI.

Methods: We included 169/646 (26.2%) patients with AF undergoing PVI with available Holter recordings before and 3, 6 and 12 months after the procedure. Patients with AF on Holter monitoring were excluded. Mean HR increase >= 20 bpm or an IST-like pattern (mean HR > 90 bpm or > 80 bpm when beta-blocking agents were used) following PVI was categorised as abnormal sinus HR response.

Results: Following PVI, mean HR +/- standard deviation increased in the entire group from 63.5 +/- 8.4 to 69.1 +/- 9.9 bpm at 3 months (p < 0.001), and to 71.9 +/- 9.4 bpm at 6 months (p < 0.001). At 12 months, mean HR was 71.2 +/- 10.1 bpm (p < 0.001). Only 7/169 patients (4.1%) met criteria for abnormal sinus HR response: mean HR was 61.9 +/- 10.6 bpm (pre-ablation), 84.6 +/- 9.8 bpm (3 months), 80.1 +/- 6.5 bpm (6 months) and 76.3 +/- 10.1 bpm (12 months). Even at 12 months, mean HR was significantly different from that pre-ablation in this group (p = 0.033). However, in patients meeting IST-like pattern criteria, mean HR at 12 months was no longer significantly different from that pre-ablation.

Conclusion: Few patients had an abnormal sinus HR response after PVI. Peak HR was observed 3 months after PVI, but HR was still significantly increased 12 months post-ablation compared with pre-ablation. An IST-like pattern was rarely observed. In these patients, HR decreased to pre-ablation values within a year.

Original languageEnglish
Number of pages7
JournalNetherlands Heart Journal
Volume68
Early online date11-Nov-2021
DOIs
Publication statusPublished - Apr-2022

Keywords

  • Atrial fibrillation
  • Cryoballoon
  • Ablation
  • Pulmonary vein isolation
  • Heart rate
  • AUTONOMIC NERVOUS-SYSTEM
  • GANGLIONATED PLEXI
  • ABLATION
  • MECHANISMS
  • RISK

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