Early peri-procedural DHF
In this study, DHF occurred in 3% of patients. Previous studies showed a 3% incidence of pulmonary edema after electrical cardioversion,6 and showed that 20–26% of patients undergoing AF ablation suffered symptoms of heart failure within 30 days after the procedure.7,8
In our study, Δheart rate was an independent predictor of early peri-procedural DHF. Either high heart rate before the procedure or decrease in heart rate after the procedure was associated with DHF.
Although preprocedure tachycardia is a recognized independent prognostic risk factor for heart failure,9 an increase in heart rate with increasing severity of heart failure is considered to be a compensatory response to the reduced cardiac reserve via activation of sympathetic activity.10,11 In addition, some AF patients develop tachycardia-induced cardiomyopathy.12In tachycardia-induced cardiomyopathy patients, it takes 4–6 weeks after sinus conversion to improve left ventricular ejection fraction.13 In these patients, low Δheart rate might induce DHF.
Decrease in heart rate can occur after the procedure. In general, heart rate is higher in patients with AF than in those with sinus rhythm,14 and sinus node dysfunction frequently occurs in patients with AF.15 Sedation during the procedure also results in a decrease in heart rate.16 These factors lead to DHF immediately after ablation, that is, early peri-procedural DHF.