| IntroductionSymptomatic persistent atrial fibrillation(AF)patients with tachycardia-bradycardia(long pauses >2.5sec)were generally treated by permanent pacemaker and Anti Arrythmatic medications previously.Catheter ablation is presently a class IIa C indication in the ESC AF guidelines(46)published in 2016,in such symptomatic patients.The Heart Rate variability(HRV)test is a non-invasive way to measure the competency of sympathetic and parasympathetic component of the Autonomic Nervous system,and its relative effect on the heart.Aim1)To compare Heart Rate Variance in patients with Persistent Atrial fibrillation with tachycardia-bradycardia before and after ablation.2)Establish the proficiency of RF catheter ablation in eliminating AF with bradycardia and improving the HRV parameters at the same time.MethodsThis study enrolled 25 patients(40 years old-80 years old)diagnosed with persistent atrial fibrillation with tachycardia and bradycardia(long pauses >2.5 sec)between January 2017 to December 2018 at the 1stAffiliated Hospital of Zhengzhou University.All the patients were failed by class I or class II Anti-arrhythmic drugs,and then underwent Radiofrequency Catheter Ablation(RFCA).24-hour Holter were performed to examine HRV and the long RR interval before and after the RFCA.The following parameters were analyzed: SDNN(standard deviation of all consecutive sizes(NN)during the total ECG record),p NN50(the proportion between adjacent NN intervals differing by more than 50 ms the percentage of the estimated total number of NN intervals),and r MSSD(square root of successive NN interval differences).Mean ± standard deviation was used to represent continuous variables.Data was analyzed by SPSS 20.0.Student’s t-test,Pearson Chi-square,and Mann-Whitney tests were performed.ResultsWe enrolled 25 patients(n=25),17 male(68 %)and 8 female(22%).The mean age was 63.16 ± 8.46 years.The HRV in the pre ablation period of the patients on AAD was either critically lower or extremely higher than the normal range(SDNN = 93.29±18.84,r MSSD = 17.46±3.74,p NN50 = 3.85±2)indicating Autonomic Nervous system imbalance,in comparison to the post ablation period HRV which was found to be within or closer to the normal range for all patients(SDNN= 135.57 ± 11.12,r MSSD = 30.064±17.74,p NN50 = 8.88±3.42)(p<0.03).There were no significant differences by sex and age.On Analysis of the study group(n=25),RFCA was found to be 95.8% sensitive in terminating AF(p=0.03).We found the HRV indices were seen to be in the normal range or closer to the normal range during the post ablation period in comparison to the pre-ablation values,which has been shown to be indicator of improved health(p=0.004).Only 2 patients did not have complete resolution of long RR intervals but still showed a positive change in the HRV parameter compared to the pre ablation HRV values.Follow upAfter 3 months of followed up,no long pauses were seen in all 23 of the reverted patients in the study group.2 patients who were found to have short paroxysmal AF with pauses still persisting,with occasional ventricular premature beats post ablation.They continued on Anti arrythmatic medications,without any symptomatic episodes in the initial 3-month period.Conclusion1)Patients with Persistent Atrial fibrillation with tachycardia-bradycardia,HRV was improved after RFCA.2)RFCA in persistent Atrial fibrillation patients is highly sensitive to the termination of Atrial fibrillation and the reversion of long pauses also improving the HRV at the same time. |
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