Impact of pulmonary vein isolation on the autonomic modulation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses.
OBJECTIVE
The efficacy of catheter-based pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and prolonged sinus pauses [bradycardia-tachycardia syndrome (BTS)] has been already described. However, the effects of PVI on autonomic modulation in BTS patients remain to be determined. We, therefore, examined the alteration in the autonomic modulation through the PVI procedure by using a heart rate variability (HRV) analysis of 24 h ambulatory monitoring.


RESULTS
This study consisted of 26 symptomatic paroxysmal AF patients either with prolonged sinus pauses on termination of AF (>3.0 s, BTS group, n = 11) or without any evidence of sinus node dysfunction (control group, matched for sex and age, n = 15) who underwent PVI. All 11 BTS patients became free from both AF and prolonged sinus pauses without pacemaker implantation (23 +/- 14 months of observation). The mean heart rate significantly increased in the control group (P < 0.05), but not in the BTS group after the PVI procedure, although the HRV parameters of root-mean-square successive differences in the adjacent NN intervals, standard deviation of the NN intervals, and high frequency did significantly decrease in both groups (P < 0.05).


CONCLUSIONS
Although the parasympathetic modulation was significantly attenuated after the PVI procedure, the mean heart rate did not increase in the BTS patients, probably due to the pre-existing sinus node dysfunction.
Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi Minato-ku, Tokyo 105-8461, Japan.
Satoru
S
Miyanaga
Teiichi
T
Yamane
Taro
T
Date
Michifumi
M
Tokuda
Yasuko
Y
Aramaki
Keiichi
K
Inada
Kenri
K
Shibayama
Seiichiro
S
Matsuo
Hidekazu
H
Miyazaki
Kunihiko
K
Abe
Ken-ichi
K
Sugimoto
Seibu
S
Mochizuki
Michihiro
M
Yoshimura
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001341:Autonomic Nervous System / Q000502:physiology*; D001919:Bradycardia / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011667:Pulmonary Veins / Q000601:surgery*; D012804:Sick Sinus Syndrome / Q000503:physiopathology; D054138:Sinus Arrest, Cardiac / Q000503:physiopathology / Q000601:surgery*; D013610:Tachycardia / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome