Effect Of Circumferential Pulmonary Vein Isolation On Deceleration Capacity Of Rate In Patients With Paroxysmal Atrial Fibrillation

Objective To observe the change of deceleration capacity of rate(DC)in patients with paroxysmal atrial fibrillation(PAF),and to investigate the effect and clinical significance of circumferential pulmonary vein isolation(CPVI)on deceleration capacity of rate of patients with paroxysmal atrial fibrillation.Methods 1 ? We selected 90 outpatient or hospitalized patients diagnosed with paroxysmal atrial fibrillation(PAF group,n=90)and 133 health subjects(control group,n=133)from January 2015 to October 2016 in the Department of Cardiology of the first affiliated hospital of Soochow university.Holter and echocardiography were used to analyze the changes of deceleration capacity of rate(DC),accelaration capacity of heart rate(AC),heart rate variability(HRV)and left atrial diameter(LAd)and left ventricular ejection fraction(EF).2?We selected 119 PAF patients who underwent left atrial circumferential pulmonary vein isolation(CPVI)from January 2013 to December 2015 in the Department of Cardiology.According to the follow-up results of 3 months after opertation,the patients were divided into non-recurrent group(n=85)and recurrent group(n=34).We retrospectively analysed the differences of DC,AC value and HRV index between recurrence group and non-recurrence group patients before operation and 3 days,3 months and 6 months after operation.RESULTS 1?Changes of deceleration capacity of rate in patients with paroxysmal atrial fibrillation:(1)Compared with the control group,the DC value,absolute value of AC,SDNN,rMSSD and LAd increased in PAF group(P <0.05),and the mean heart rate and LF/ HF index decreased(P <0.05);(2)The DC value had no significant difference between the male and female both in the control group and the PAF group.But in the PAF group,the DC value of male increased(P<0.05)compared with the control group,while the DC value of female had an increasing trend;(3)Regardless of the control group(r<-0.262,P<0.01)or PAF group(r<-0.548,P<0.01),DC values were negatively correlated with age;Compared with control group,the DC values of age <60 in PAF group increased(P<0.05),and over 60 years the DC value had an increasing trend;(4)Compared with the control group,the left atrial diameter of PAF group increased(P<0.05),but both LAd ? 40 mm or LAd>40mm in the PAF group,DC values were higher than those of the control group(P<0.05).2?Effect of CPVI on deceleration capacity of rate of patients with paroxysmal atrial fibrillation:(1)The DC value,AC absolute value,SDNN,RMSSD and LF/HF all significantly decreased in the immediate postoperative compared with the preoperative both in the recurrence group and non-recurrence group(P<0.01);(2)Both in the recurrent group and the non-recurrence group,The DC value of three and six months after operation was higher than that of the immediate postoperative(P<0.05),but there was no significant difference between the DC value of three and six months after operation(P<0.05).(3)The DC value of the recurrence group was higher than that of the non-recurrent group in 3 and 6 months after operation(P<0.05).Conclusion 1?The DC value increased in patients with PAF,suggesting that the vagus nerve function increased;2?The DC value of PAF patients decreased after CPVI,suggesting that CPVI had vagal denervation but this function was partially reversible;3?The recurrence of PAF patients was correlated with the recovery of DC value in 3-6 months after CPVI,suggesting that the postoperative DC value may be an important predictor of recurrence in patients with PAF after CPVI.