Evaluation To Autonomic Nervous Function After Circumferential Pulmonary Vein For Paroxysmal Atrial Fibrillation

Objective:To evaluate the changes of the autonomic nervous function after circumferentialpulmonary vein isolation(CPVI) for paroxysmal atrialfibrillation(PAF) by analysis th e changes of the deceleration capacity of heart rate(DC) and heart rate variability. Methods:Successful CPVI was achieved in 50 consecutive patients with atrial fibrillation(PAF group).Serial 24h-Holter recordings were obtained before and 3 days,1months, 3months after CPVI to analysis the average HR, DC and the time and frequency-domain(SDNN,r MSSD,Ln HF,Ln LF,LF/HF),analysis of DC and HRV were obtained by the 24h-holter.All these parameters were compared between pre-and post-operation between groups with and without PAF recurrences.Meanwhile select 30 healthy individuals as normal control(control group),Average HR and HRV before CPVI were compared between control group and PAF group. Results: 1.PAF group,53 PAF patients(34 males) meet the analysis criterion,with mean age of 60.6± 7.2(40-73)years, mean duration of PAF6.3 ± 8.1(1-28)years,mean left atrial diamension(LAD)38.2±4.9(31-53)mm,mean left ventricular ejection fraction(LVEF)66±8%(46%-75%).Among these patients,38 were free from PAF(non-recurrence group)and 15 had late PAF recurrence(recurrence group) at 3 month follow-up.The first of success ratio was about 71.7%. 2.In the PAF group,average HR and LF/HF were significantly lower and other data(DC,SDNN,r MSSD,Ln HF,Ln LF)were significantly higher than in the control group(P<0.001). 3.At 3 days after CPVI,DC,r MSSD and Ln HF power were significantly lower in the non-cecurrence group than in the recurrence group(P < 0.05).But there were no significantly differences between the recurrence group and the non-recurrence group in average HR,SDNN,Ln LF and LF/HF(P>0.05). 4.In the non-recurrence group,average HR increased at 3days after CPVI and remained elevated for 3 months at least(P<0.05),The DC, time- and frequency-domain HRV parameters including the SDNN,r MSSD,Ln LF and Ln HF,decreased at 3 days after CPVI and remained attenuated for 3 months at least(P<0.05).In the recurrence group,there were no significant differences between the pre- and the post-operation in average HR and HRV(P>0.05).There were no significant difference between the recurrence group and the non-recurrence group in LF/HF(P>0.05). Conclusion: 1.The vagal activation of the PAF patients remains on a comparatively higher status;low activiation of vagal of the PAF patients after CPVI could be helpful to prevent the recurrence.2.There is a negative correlation between the decline of DC and the recurrence.Denervation of the vagal coud be one of the mechanism of healing PAF. ANScan self-healing after the damage of CPVI. 3.DC has a well correlation with HRV. 4.CPVI is a safe and effective technique for PAF patients.