Skip to main content

ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1426531
This article is part of the Research Topic Autonomic Function and Neuromodulation in Cardiovascular Disease View all articles

Do extra-pulmonary triggers or autonomic neural activity affect rhythm control by antiarrhythmic drugs in patients with post-ablation atrial fibrillation recurrence?

Provisionally accepted
Hanjin Park Hanjin Park Hee Tae Yu Hee Tae Yu *Daehoon Kim Daehoon Kim Je-Wook Park Je-Wook Park Tae-Hoon Kim Tae-Hoon Kim Jae-Sun Uhm Jae-Sun Uhm Boyoung Joung Boyoung Joung Moon-Hyoung Lee Moon-Hyoung Lee Chun Hwang Chun Hwang Hui-Nam Pak Hui-Nam Pak
  • Yonsei University Health System, Seoul, Seoul, Republic of Korea

The final, formatted version of the article will be published soon.

    Background: The role of anti-arrhythmic drugs (AADs) in recurrent atrial fibrillation (AF) after catheter ablation (CA) is not fully understood. The aim of this study was to explore the effects of AADs in patients who recurred after AFCA depending on extra-pulmonary vein triggers (ExPVTs) and post-ablation heart rate variability (HRV) parameters. Methods: We analyzed 2,036 patients who underwent de-novo AFCA and 486 patients with post-AFCA recurrence who underwent rhythm control with AADs. We investigated the effects of ExPVTs and 3rd month HRV parameters on the post-AFCA recurrence and subsequent AAD responsiveness. Results: A total of 486 out of 2,036 patients developed clinical recurrence of AF and subsequently underwent rhythm control with AADs. 486 out of 310 patients (63.8%) remained free of second recurrence at 1-year. Post-AFCA recurrence was significantly higher in patients with ExPVT (Log-rank p<0.001, HR 1.45 [1.16-1.83], p=0.001) or higher 3rd month root mean square of the differences between successive RR intervals (rMSSD) (Log-rank p<0.001, HR 1.36 [1.11-1.65], p=0.003) than their counterparts. Patients with ExPVTs during the de-novo procedure had significantly higher 3rd month rMSSD (15.0 [11.0-23.0] vs. 17.0 [11.0-28.0], p=0.022). Patients with high 3rd month rMSSD had higher rate of ExPVTs during the repeat procedure (n=160, 41.0% vs. 22.2%, p=0.019). Among patients with recurrent AF after AFCA, post-AAD recurrence did not differ depending on the presence of ExPVT (Log-rank p=0.455, HR 1.12 [0.78-1.69], p=0.436) or 3rd month rMSSD (Log-rank p=0.457, HR 1.16 [0.87-1.55], p=0.300). Post-AAD recurrence did not differ between class IC and III AADs (p for interaction=0.311). Conclusions: ExPVT and post-procedural high rMSSD are independent risk factors for post-AFCA recurrence but not for AAD response in patients with recurrent AF. AADs may suppress ExPVTs and modulate cardiac autonomic activity after post-AFCA recurrence.

    Keywords: Atrial Fibrillation, Catheter Ablation, Antiarrhythmic drugs, Extra-pulmonary vein trigger, Heart rate variability

    Received: 01 May 2024; Accepted: 25 Sep 2024.

    Copyright: © 2024 Park, Yu, Kim, Park, Kim, Uhm, Joung, Lee, Hwang and Pak. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Hee Tae Yu, Yonsei University Health System, Seoul, 03722, Seoul, Republic of Korea

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.