Heart rate variability and inappropriate sinus tachycardia after catheter ablation of supraventricular tachycardia

Abstract

Sinus tachycardia has been reported after radiofrequency catheter ablation of supraventricular tachycardia. Frequently, these patients require beta-blocking agents for symptomatic control. The purpose of this study was to evaluate prospectively the incidence of inappropriate sinus tachycardia and heart rate variability after ablation of atrioventricular nodal reentrant tachycardia and accessory pathways. Patients undergoing ablation had 24-h ambulatory monitoring ECG (Holter) performed before the procedure, on the day of the ablation, and 3 months afterwards. There were 170 patients, mean age 48 +/- 23 years; 93 were female. A complete study of the 24-h Holter with analysis of heart rate variability: SD, rMSSD, pNN50, high and low frequency was obtained. There was a low prevalence of inappropriate sinus tachycardia after the ablation procedure (10 of 170 patients: five with four atrioventricular nodal reentry, with posteroseptal accessory pathways and one of the latter following ablation of the left accessory pathway). There was no modification of time and frequency domain parameters of heart rate variability in the remaining patients who underwent radiofrequency ablation. Holter monitoring 3 months after ablation showed that parameters of heart rate and heart rate variability had normalized in patients who had developed inappropriate sinus tachycardia. Inappropriate sinus tachycardia may be initiated by both radiofrequency ablation of atrioventricular nodal reentrant tachycardia and radiofrequency ablation of posteroseptal accessory pathways. Specific damage to the posteroseptal region is responsible for these changes, which usually recover spontaneously after 3 months.

Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins

“…1-6,16 -19 In the present study, the prevalence of inappropriate sinus tachycardia was 6.7%, similar to that in previous reports regarding ablation of supraventricular tachycardias. [1][2][3]17,18 We also found decreases in SDRR, rMSSD, and HF and increases in mean and maximal sinus rate and LF/HF ratio, which indicates autonomic dysfunction, just like the findings after ablation of supraventricular tachycardias. Furthermore, no significant changes in HR and HRV were noted in our control group, which indicates autonomic dysfunction after ablation of PVs was not related to the transseptal procedure.…”

“…[1][2][3][4][5][6] Therefore, we performed 24-hour Holter monitoring at 1 and 6 months after ablation of PVs, respectively, to see the chronic changes in HRV. The results showed that an increase in HR and a decrease in HRV recovered at 1 month after ablation of PVs, indicating a transient dysfunction of autonomic nervous system, just as the findings after ablation of supraventricular tachycardias.…”

“…[1][2][3][4][5][6] Several reports have demonstrated an increase in heart rate (HR) and a decrease in HR variability (HRV) after ablation of slow atrioventricular nodal, posteroseptal, and para-hisian accessory pathways. [2][3][4][5][6] These reports suggested that transient parasympathetic nervous withdrawal might be one of the mechanisms that causes these HR effects when RF energy is applied around these pathways. Recently, RF catheter ablation of pulmonary veins (PVs) has been demonstrated to cure focal atrial fibrillation (AF).…”

An Experimental Study on the Site Dependency and Mechanism of Vagal Denervation Following Radiofrequency Catheter Ablation for Supraventricular Arrhythmias Including Atrial Fibrillation

“…[6][7][8][9][10][11][12] Kocovic, et al 7) first described the parasympathetic damage that occurs in combination with an atrial septal RFCA during therapy for atrioventricular (AV) nodal reentrant tachycardia (AVNRT) or AV reciprocating tachycardia utilizing a septal Kent bundle, and speculated that it was due to injury to the vagal ganglia or neural fibers existing in that area. They also reported that RFCA of a left lateral Kent bundle did not cause any parasympathetic damage.…”

“…Even if there is some discrepancy between the human and canine cardiac parasympathetic distribution, it is natural that an atrial septal RFCA would yield some vagal damage to the SA node even in human hearts. [6][7][8][9][10][11][12] Recently, RFCA application to the pulmonary veins (PVs) or in the vicinity of their ostia has become an effective strategy for treating paroxysmal atrial fibrillation (AF). [20][21][22][23][24] According to the above-mentioned neural distribution, RFCA of the right PVs could also cause vagal denervation similar to that with AVNRT therapy.…”