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.