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Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation

Styczkiewicz, Katarzynaa,b; Spadacini, Giammarioc; Tritto, Massimoc; Perego, Giovanni B.a; Facchini, Marioa; Bilo, Grzegorza,d; Kawecka-Jaszcz, Kalinab; Czarnecka, Danutab; Malfatto, Gabriellaa; Parati, Gianfrancoa,d

Journal of Cardiovascular Medicine: May 2019 - Volume 20 - Issue 5 - p 297–305
doi: 10.2459/JCM.0000000000000791
Research articles: Arrhythmias

Aims Ablation procedures for the treatment of atrial fibrillation lead to changes in autonomic heart control; however, there are insufficient data on the possible association of these changes with atrial fibrillation recurrence. The study aim was to assess the effects of pulmonary vein isolation (PVI) on cardiac autonomic modulation and atrial fibrillation recurrence.

Methods We screened 52 patients with atrial fibrillation referred for PVI, of whom 20 patients met inclusion and exclusion criteria, and were enrolled in the study and followed over 6 months. Beat-to-beat blood pressure monitoring was performed 1–2 days before PVI, 1 and 6 months after PVI. We estimated pulse interval variability and spontaneous baroreflex sensitivity (BRS) both in the time and frequency domains, and performed the Valsalva manoeuvre assessing the Valsalva ratio.

Results During 6 months after PVI, atrial fibrillation recurrence was observed in six patients. One month after PVI, pulse interval variability and BRS (sequence method) significantly decreased in all patients, returning to preintervention values by 6 months. Patients without atrial fibrillation recurrence at 1 month showed a transient reduction in pulse interval variability (frequency domain) and in BRS (both methods) in contrast to those with atrial fibrillation recurrence. A significant decrease in the Valsalva ratio observed at 1 month was maintained at 6 months after PVI in both groups.

Conclusion Successful PVI may lead to transient autonomic alterations reflected by a reduction in pulse interval variability and BRS, with more prolonged changes in the Valsalva ratio. The efficacy of PVI in preventing atrial fibrillation recurrence seems to be related to transient parasympathetic atrial denervation.

aIRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy

bThe First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland

cElectrophysiology and Cardiac Pacing Operative Unit, Humanitas Mater Domini Hospital, Castellanza (VA)

dDepartment of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy

Correspondence to Katarzyna Styczkiewicz, MD, PhD, Department of Cardiology, Specialistic Hospital in Brzozow, Subcarpathian Oncological Center, Bielawskiego Street 18, Brzozow 36-200, Poland Tel: +48 509893645; fax: +48 13 4307940; e-mail:

Received 6 November, 2018

Revised 29 January, 2019

Accepted 28 February, 2019

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© 2019 Italian Federation of Cardiology. All rights reserved.