Abstract
B ackground:Cather ablation (CA) is a well-recognized treatment alternative for
atrial fibrillation (AF) patients despite more than 20%
ablation-treated patients suffering from AF recurrence. The underlying
mechanism of AF recurrence post-ablation is probably associated with
high cardiac parasympathetic activity, which can be assessed with
deceleration capacity (DC) of heart rate. Given that the relationship
between DC and AF recurrence is still controversial, this systematic
review and meta-analysis was performed to investigate the
characteristics of DC in patients with and without AF recurrence,
evaluating the prognostic value of DC in AF patients after CA.
Methods: A literature search
was systematically performed in the Embase, PubMed, Web of Science,
China National Knowledge Infrastructure (CNKI), and Wanfang databases
until October 01, 2023. The observational studies reporting either the
pre- and post-ablation DC in both recurrence and non-recurrence groups
or the ratios based on DC for predicting AF recurrence were mainly
included. Weighted mean differences (WMD) or odds ratios (OR) based on
DC would be calculated with a random-effect model, if heterogeneity
estimated with the I 2 index and Q statistic was
significant (I 2 > 50% or P< .05); otherwise, a fixed-effect model would be utilized.
Results: A total of 8 observational studies involving 914 AF
patients treated with radiofrequency or cryoballoon ablation were
included in this study.
Ablation-treated patients with AF recurrence had the higher DC
post-ablation in relation to those without recurrence (WMD, 1.00;
95%CI, 0.33 to 1.67; P < .01), which was present up to
3 months of follow-up (WMD, 1.54; 95%CI, 1.11 to 1.96; P< .01), whereas there was no statistical significance in DC
prior to ablation between recurrence and non-recurrence groups (WMD,
0.34; 95%CI, -0.12 to 0.79; P = .15). The high DC post-ablation
was a risk factor for AF recurrence in ablation-treated patients (OR,
2.17; 95%CI, 1.44 to 3.25; P < .01).
Conclusion: The high DC post-ablation was associated with the
risk of AF recurrence, suggesting that DC may act as a prognostic
indicator in AF patients treated with CA.
Keywords: Deceleration capacity; Atrial fibrillation; Catheter
ablation; Recurrence; Meta-analysis; Systematic review.