Circulation, Vol 88, 1671-1681, Copyright © 1993 by American Heart Association
DZ Kocovic, T Harada, JB Shea, D Soroff and PL Friedman
BACKGROUND. Persistent inappropriate sinus tachycardia has been reported as
a complication after radiofrequency (RF) ablation of the fast
atrioventricular (AV) nodal pathway. The purpose of this study was to
evaluate the prevalence of this complication and its mechanism using heart
rate variability analysis. METHODS AND RESULTS. Time and frequency domain
analysis of heart rate was performed in the electrophysiology laboratory
immediately before and immediately after RF ablation in 64 patients with
supraventricular tachycardia. Ablation targets in these 64 patients
included the fast AV nodal pathway (n = 3), the slow AV nodal pathway (n =
14), a posteroseptal accessory pathway (n = 23), and a left lateral
accessory pathway (n = 24). A control group of 21 patients undergoing
diagnostic study but not ablation underwent identical analysis immediately
before and at the conclusion of their procedure. Patients undergoing
ablation also had time and frequency domain analysis performed on
ambulatory 24-hour Holter tapes recorded before ablation and at 1 day, 1
month, and 6 months after ablation. Compared with preablation values, time
domain analysis immediately after ablation revealed a significant increase
in mean heart rate and significant reductions in heart rate variability
expressed as SD, MSSD, and PNN50 in patients undergoing AV nodal
modification or posteroseptal accessory pathway ablation. Frequency domain
analysis revealed marked attenuation of high frequency (0.15 to 0.40 Hz)
components, indicating parasympathetic denervation. These acute changes
were not seen after ablation of left lateral accessory pathways or after
diagnostic study without ablation. Time and frequency domain analysis of
24-hour ambulatory Holter monitors performed serially after ablation
revealed resolution of abnormalities of heart rate and of heart rate
variability 1 to 6 months after ablation, with reappearance of the high
frequency parasympathetic component suggestive of reinnervation.
CONCLUSIONS. RF ablation in the anterior, mid, and posterior regions of the
low interatrial septum may disrupt preganglionic or postganglionic
parasympathetic fibers located in these regions that are destined to
innervate the sinus node. Such fibers become more scarce along the left AV
groove with increasing distance from the posteroseptal space.
Parasympathetic denervation may be one mechanism for persistent
inappropriate sinus tachycardia after RF ablation.
ARTICLES
Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart
Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, MA 02115.
This article has been cited by other articles:
 |
|
 |
|
  S. Ketels, R. Houben, K. Van Beeumen, R. Tavernier, and M. Duytschaever Incidence, timing, and characteristics of acute changes in heart rate during ongoing circumferential pulmonary vein isolation Europace, December 1, 2008; 10(12): 1406 - 1414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.J. Reed, C.E. Robertson, and P.S. Addison Heart rate variability measurements and the prediction of ventricular arrhythmias QJM, February 1, 2005; 98(2): 87 - 95. [Full Text] [PDF]
|
|
|
|
|
|
B. Nilsson, X. Chen, S. Pehrson, Jør. Hilden, and J. H. Svendsen Increased resting heart rate following radiofrequency catheter ablation for atrial fibrillation Europace, January 1, 2005; 7(5): 415 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Hamdan, R. L. Page, C. J. Sheehan, J. D. Zagrodzky, S. L. Wasmund, K. Ramaswamy, J. A. Joglar, and M. L. Smith Increased sympathetic activity after atrioventricular junction ablation in patients with chronic atrial fibrillation J. Am. Coll. Cardiol., July 1, 2000; 36(1): 151 - 158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Duru, U. Bauersfeld, and R. Candinas Autonomic effects of radiofrequency catheter ablation Europace, January 1, 2000; 2(2): 181 - 185. [Abstract] [PDF]
|
|
|
|
 |
|
 G Butera, D Bonnet, L Iserin, D Sidi, J Kachaner, and E Villain Total cavopulmonary and atriopulmonary connections are associated with reduced heart rate variability Heart, December 1, 1999; 82(6): 704 - 707. [Abstract] [Full Text]
|
|
|
|
 |
|
 M.-H. Hsieh, C.-W. Chiou, Z.-C. Wen, C.-H. Wu, C.-T. Tai, C.-F. Tsai, Y.-A. Ding, M.-S. Chang, and S.-A. Chen Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins Circulation, November 30, 1999; 100(22): 2237 - 2243. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Paydak, J. G. Kall, M. C. Burke, D. Rubenstein, D. E. Kopp, R. J. Verdino, and D. J. Wilber Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter : Time to Onset, Determinants, and Clinical Course Circulation, July 28, 1998; 98(4): 315 - 322. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Singh, P. I. Johnson, R. E. Lee, E. Orfei, V. A. Lonchyna, H. J. Sullivan, A. Montoya, H. Tran, W. H. Wehrmacher, and R. D. Wurster TOPOGRAPHY OF CARDIAC GANGLIA IN THE ADULT HUMAN HEART J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 943 - 953. [Abstract] [Full Text]
|
|
|
|
|
|
T. F. o. t. E. S. o. C. t. N. A. S. o. P. Electrophysiology Heart Rate Variability : Standards of Measurement, Physiological Interpretation, and Clinical Use Circulation, March 1, 1996; 93(5): 1043 - 1065. [Full Text]
|
|
|
|
|
|
J. M. Kalman, R. J. Lee, W. G. Fisher, M. C. Chin, P. Ursell, C. A. Stillson, M. D. Lesh, and M. M. Scheinman Radiofrequency Catheter Modification of Sinus Pacemaker Function Guided by Intracardiac Echocardiography Circulation, November 15, 1995; 92(10): 3070 - 3081. [Abstract] [Full Text]
|
|