Pulmonary Vein and Superior Vena Cava Isolation for Atrial Fibrillation and Their Long Term Effects on Autonomic Nerve Function

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Background: Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) modifies the autonomic nerve function. The aim of this study is to reveal the time course of heart rate variability (HRV) after pulmonary vein (PV) and superior vena cava (SVC) isolation by long term follow-up. Methods: 84 patients who underwent RFCA of AF were included. PV isolation was performed in 70 patients (PVI-group). The other 14 patients underwent SVC isolation in addition to PVI (SVC-group). HRV was analyzed using 24-hour Holter monitoring performed on average 4 (early-period) and 15 (late-period) months after RFCA. Mean heart rate (MHR), time-domain and frequency-domain were estimated. These parameters were compared with those of 50 normal subjects (Control-group). Results: In early period, both groups had significant increase in MHR and decrease in standard deviation of NN intervals (SDNN) compared with control-group. In addition, SVC-group had even higher MHR (P<0.005) and lower SDNN (P=0.011) than PVI-group. However, MHR returned to the baseline completely in late-period in both groups. SDNN showed significant recovery in late-period, but it was still lower than control-group (P<0.0001). Similarly, some of other parameters in HRV showed incomplete recovery in late-period. Conclusions: Autonomic nerve function of SVC-group was suppressed more than that of PVI-group. HRV in both groups recovered, but not completely to the baseline within 15 months.