Higher very short-term blood pressure variability is associated with lower atrial fibrillation recurrence after catheter ablation

TL;DR

Higher beat-to-beat blood pressure variability at night is linked to a lower chance of atrial fibrillation returning after ablation treatment.

Contribution

This study shows that very short-term blood pressure variability is a novel predictor of atrial fibrillation recurrence after ablation.

Findings

Patients with higher nighttime blood pressure variability had significantly lower AF recurrence rates.

Higher BPV was associated with reduced risk of AF recurrence in statistical models.

Cuffless pulse transit time monitoring may help assess risk before ablation.

Abstract

Blood pressure variability (BPV) is a cardiovascular risk marker independent of mean blood pressure. Prior studies have suggested potential associations between BPV and atrial fibrillation (AF) recurrence, but the relevance of very short-term, beat-to-beat BPV remains uncertain.

In this single-center retrospective cohort study, we enrolled 153 consecutive patients undergoing first-time AF ablation who underwent pre-procedural overnight polygraphy with simultaneous pulse transit time-based beat-to-beat blood pressure monitoring. Very short-term BPV was quantified as the standard deviation (SD) of nighttime beat-to-beat systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP); patients were dichotomized at the median. The primary endpoint was the first recurrence of AF lasting ≥ 30s beyond a 3-month blanking period during 12 months of follow-up.

During follow-up, AF recurrence occurred in 15 patients (9.8%). Kaplan–Meier curves showed significantly lower recurrence rates in the higher BPV groups (SD of SBP: P = 0.015; SD of DBP: P = 0.002; and SD of MBP: P = 0.003). In univariable Cox proportional hazards models, higher BPV was associated with lower recurrence risk (SD of SBP: hazard ratio 0.519, 95% confidence interval 0.311–0.865; SD of DBP: hazard ratio 0.258, 95% confidence interval 0.101–0.664; and SD of MBP: hazard ratio 0.251, 95% confidence interval 0.099–0.638).

Higher nighttime very short-term BPV was associated with lower AF recurrence after first-time ablation. Pulse transit time-based cuffless monitoring may provide a practical method for preprocedural risk stratification; confirmation via multicenter studies is warranted.

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