Outflow tract premature ventricular depolarizations after atrial fibrillation ablation may reflect autonomic...

Autonomic modulation following catheter ablation of atrial fibrillation may promote the development of catecholamine-sensitive arrhythmias, such as outflow tract (OT) ventricular premature depolarizations (VPDs). The purpose of this study was to determine the incidence and prognostic significance of OT VPDs occurring in patients after atrial fibrillation (AF) ablation.

We prospectively examined 53 consecutive patients undergoing wide-area circumferential antral pulmonary vein (PV) isolation; no patients had evidence of OT VPDs on 24 h of preprocedural telemetry monitoring. Cases (OT+) had postprocedure telemetry monitoring with >30 continuous beats or >3/min OT VPDs. Clinical follow-up included transtelephonic monitoring at 6 weeks, 6 months, and 1 year.

The incidence of OT VPDs in this population was 11% (6/53). There was no difference in AF recurrence at 1 year between those with or without OT VPDs (17 vs 28%, p = 0.6). There was a strong association with higher immediate postprocedure heart rate (HR) in OT+ compared to OT- patients (86 vs 76, p = 0.03); this difference persisted at 1 year (79 vs 60, p < 0.01). OT VPDs resolved in 5/6 of the OT+ patients over the 1-year follow-up. In a multivariable linear regression model, OT VPDs were associated with higher HR (odds ratio (OR) 1.14 [1.10-1.18], p < 0.001) despite adjustment for medication dose.

A minority of patients undergoing antral PV isolation develops OT VPDs associated with a sustained increase in mean heart rate; this effect may result from the modulation of adjacent autonomic ganglia.