Filiz Kızılırmak Yılmaz1, Fatih Yılmaz2, Arzu Yıldırım1, Hacı Murat Güneş1, Tayyar Gökdeniz3, Fatih Erkam Olgun1, Tuğba Aktemur1, Ümeyir Savur4, Fethi Kılıçaslan1

1Department of Cardiology, Medipol University Faculty of Medicine, İstanbul, Turkey
2Clinic of Cardiology, Kartal Koşuyolu Research and Education Hospital, İstanbul, Turkey
3Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
4Clinic of Cardiology, Gaziosmanpaşa Research and Education Hospital, İstanbul, Turkey

Keywords: Atrial fibrillation; autonomic nervous system; catheter ablation


Introduction: In this study, we aimed to investigate the relationship between autonomic dysfunction (AD) determined according to the blood pressure (BP) and heart rate (HR) response in exercise treadmill test (ETT) prior to cryoballoon ablation (CBA), and the recurrence of atrial fibrillation (AF) after CBA in patients with paroxysmal AF.

Patients and Methods: Seventy-six patients (mean age 53 ± 11 years, 61.8% male) with paroxysmal AF who underwent CBA were enrolled. Before CBA the ETT was performed by all patients. BP and HR responses in ETT were compared between patients with and without AF recurrence.

Results: AD rate was significantly higher in the group with recurrence compared to the non-recurrent group (p< 0.001). In addition to AD, age, female gender, and lower exercise capacity were also associated with post-CBA AF recurrence (p> 0.05 for all). Examining AD parameters, systolic blood pressure at peak exercise (SBPpeak) (p< 0.001) and diastolic blood pressure at peak exercise (DBPpeak) (p< 0.001), slow heart rate recovery (HRR) (p< 0.001) were significantly higher in the recurrent group.

Conclusion: AD may be associated with AF recurrence after CBA in patients with paroxysmal AF. SBPpeak, DBPpeak, and slow HRR appear to be predictors of AF recurrence after ablation.

Ethics Committee Approval

The approval for this study obtained from İstanbul Medipol University, Non-invasive Clinical Research Ethics Committee (Decision No: 1180, Date: 25.12.2019).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - FKY; Analysis/Interpretation - TG, HMG; Data Collection - FEO; Writing - FKY; Critical Revision - AY, FY; Final Approval - TA; Statistical Analysis - TG, ÜS; Overall Responsibility - FK, FKY.

Conflict of Interest

The authors declared that there was no conflict of interest during the preparation and publication of this article.

Financial Disclosure

The authors declared that this study has received no financial support.