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Objective: Surgical pulmonary vein isolation (PVI) as treatment of choice for paroxysmal atrial fibrillation (PAF) isolates conduction from PVs from atrial tissue and may also isolate atria from autonomic inervation. Abnormal activity of sympathetic and parasympathetic cardiac systems may induce atrial fibrillation. This study describes dynamic changes in heart rate variability (HRV) and autonomic activity (AA) after successful bipolar radiofrequency PVI in short and long-term follow-up.
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Grzegorz Suwalski1, Piotr Suwalski1, Jurij M. Kalisnik2, Mariusz Sledz1, Julita Switaj1, Anna Oginska1, Borut Gersak2, Kazimierz B. Suwalski1.
1Cardiac Surgery Derpartment, Medical University of Warsaw, Warsaw, Poland, 2Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubjana, Slovenia.
Methods: 27 patients who underwent coronary artery bypass grafting and successful (sinus rhythm for 1 year) off-pump bipolar radiofrequency PVI for PAF were prospectively followed 3, 6 and 12 months after surgery including 24 hours Holter ECG. At each time HRV and AA parameters were calculated: mean NN-interval (mRR), standard deviation of NN-intervals (SDNN), standard deviation of averaged NN-intervals (SDANN), root mean square of successive differences (rMSSD), low frequency power (0,04-0,15 Hz; specific parameter for sympathetic activity), high frequency power (0,15-0,4 Hz; specific parameter for parasympathetic activity) and LF:HF ratio.
Results: Before surgery there were high HRV and AA parameters recorded. In 3, 6 and 12 months time points there was progressive reduction of HRV and AA observed reaching statistical significance at 6 and 12 months after surgery (p<0,05). Respectively, rates before and 3, 6, 12 months after surgery were: for mRR (945,3 +/-160; 870 +/-122; 902,1 +/-171; 902 +/-217 ms), for SDANN (122,4 +/-113; 95,8 +/-47; 91,8 +/-31; 80,5 +/-42 ms), for rMSSD (79,2 +/-93; 68,9 +/-49; 60,2 +/- 41; 45 +/-20 ms). Graph shows dynamic changes in sympathetic and parasympathetic activity. LF:HF ratios were 0,98 (+/-0,7); 0,91 (+/- 0,6); 0,8 (+/- 0,6); 0,67 (+/-0,3) before, 3, 6, 12 months after surgery, respectively. Statistically significant constant reduction in LF:HF ratio (p<0,05) is observed due to oncoming parasympathetic dominance 12 months after ablation.
Conclusions: This study shows that successful PVI for PAF changes autonomic cardiac nervous system activity. Described reduction of HRV and sympathetic activity with oncoming parasympathetic dominance may be result of surgical procedure on left atrial tissue. 
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