Abstract
To determine the relation between the creation of endocardiallesions and alterations in autonomic tone, we analyzed heart ratevariability in patients undergoing radiofrequency catheter ablation forsymptomatic supraventricular tachycardia.
Elevated heart rates are frequently noted after radiofrequency catheterablation for supraventricular arrhythmias. It has been postulated that thiselevation may be secondary to alterations in cardiac autonomic tone. Sinceheart rate variability is a measure of autonomic nervous system activity, weused this technique to examine the heart rate elevation and to characterizepostablation autonomic changes.
Thirty-eight patients undergoing 44 radiofrequency catheter ablationprocedures were included in the study. Total arrhythmic substrates treatedincluded 34 accessory pathways and 13 AV nodes with dual physiology.Twenty-four-hour ambulatory electrocardiographic recordings were obtained ina drug-free state prior to, ablation early postablation, and latepostablation. Spectral and nonspectral analyses of heart rate variabilitywere performed. Subgroup analyses were also done on specific cohorts.Subgroups included patients undergoing accessory pathway ablations, AV nodemodifications, and ablation of septal and nonseptal targets. To determinewhether the amount of tissue damage was related to changes in heart ratevariability, we analyzed the relation between the total energy delivered tothe endocardium and the peak change in creatine kinase and heart ratevariability.
In this population, a significant transient increase in heart rate wasnoted following radiofrequency ablation. All time and frequency domainparameters of heart rate variability showed significant reversibledecreases. These changes were independent of target site and arrhythmiasubstrate. There was no correlation noted between the changes in heart ratevariability and either the total amount of energy applied to the endocardiumor the change in creatine kinase.
Increased heart rates and decreased heart rate variability occurfollowing radiofrequency catheter ablation for supraventricular tachycardia. Clinically, the predominant effect is that of decreased parasympathetic tone. Since these transient changes are independent ofarrhythmic substrate or ablation site in the atria, a rich parasympathetic innervation of the heart is proposed.
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Verdino, R.J., Tracy, C.M., Solomon, A.J. et al. Alterations in Heart Rate Following Radiofrequency Ablation in the Treatment of Reentrant Supraventricular Arrhythmias: Relation to Alterations in Autonomic Tone. J Interv Card Electrophysiol 1, 145–151 (1997). https://doi.org/10.1023/A:1009759200219
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DOI: https://doi.org/10.1023/A:1009759200219