Fractal complexity alternations in paroxysmal atrial fibrillation patients with and without recurrence after pulmonary vein isolation

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Ting-Wei Ernie Liao MD, Cheng-Hung Li MD, Yenn-Jiang Lin MD, Shih-Lin Chang MD, Yu-Feng Hu MD, Fa-Po Chung MD, Tze-Fan Chao MD, Jo-Nan Liao MD, Hui-Wen Yang PhD, Men-Tzung Lo PhD, Shih-Ann Chen MD, Li-Wei Lo MD
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引用次数: 0

Abstract

Background

Pulmonary vein isolation (PVI) is a cornerstone therapy for paroxysmal atrial fibrillation (PAF). The variations in nonlinear heart rate variability (HRV) between patients with and without recurrences remain unclear. We aimed to characterize the nonlinear HRV before and after PVI in patients with and without recurrence.

Methods

Twenty-five drug-refractory PAF patients (56.0 ± 9.1 years old, 20 males) who received PVI were enrolled. Holter electrocardiography were performed before, 1–3, and 6–12 months after PVI. After 8.2 ± 2.5 months of follow-ups after PVI, patients were divided into two groups: the recurrence (n = 8) and non-recurrence (n = 17) groups. Linear and nonlinear HRV variables were analyzed, including the Poincaré Plot analysis and the Detrended Fluctuation Analysis (DFA).

Results

The non-recurrence group, but not the recurrence group, had decreased high-frequency component (HF), the root mean square of successive RR interval differences (RMSSD), and the Poincaré Plot index SD1 1–3 months after PVI and increased DFAslope2 6–12 months after PVI. The non-recurrence group's LF/HF ratio and DFAslope1 decreased significantly 1–3 and 6–12 months after PVI, respectively, whereas there was no significant change in the recurrence group after PVI.

Conclusions

Significantly reduced vagal tone 1–3 months after PVI, increased long-term fractal complexity 6–12 months after PVI, and decreased sympathetic tone as well as short-term fractal complexity 1–3 and 6–12 months after PVI led to a better AF-free survival after PVI. These findings suggest that neuromodulation and heart rate dynamics play crucial roles in AF recurrence following PVI.

Abstract Image

肺静脉隔离后复发与不复发阵发性心房颤动患者分形复杂度的变化
背景肺静脉隔离(PVI)是阵发性心房颤动(PAF)的基础治疗方法。非线性心率变异性(HRV)在复发和无复发患者之间的变化尚不清楚。我们的目的是描述有和无复发的PVI患者在PVI前后的非线性HRV。方法采用PVI治疗的难治性PAF患者25例,年龄56.0±9.1岁,男性20例。术前、术后1-3个月、6-12个月分别进行动态心电图。PVI术后随访8.2±2.5个月,将患者分为复发组(n = 8)和不复发组(n = 17)。分析了线性和非线性HRV变量,包括poincar图分析和去趋势波动分析(DFA)。结果复发组与非复发组相比,PVI术后1 ~ 3个月高频分量(HF)、连续RR间隔差均方根(RMSSD)、poincar Plot指数(sd11)均降低;PVI术后6 ~ 12个月DFAslope2升高。PVI后1-3个月、6-12个月,未复发组LF/HF比值、DFAslope1显著下降,而复发组PVI后无明显变化。结论PVI术后1-3个月的迷走神经张力明显降低,6-12个月的长期分形复杂性明显增加,1-3个月和6-12个月的交感神经张力和短期分形复杂性明显降低,可提高PVI术后无af生存期。这些发现表明,神经调节和心率动力学在PVI后房颤复发中起关键作用。
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来源期刊
CiteScore
3.40
自引率
0.00%
发文量
88
审稿时长
6-12 weeks
期刊介绍: The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.
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