Changes of autonomic nervous system activity on idiopathic premature ventricular complexes after radiofrequency ablation

Abstract Objective Radiofrequency catheter ablation (RFCA) is a standard treatment for idiopathic premature ventricular complexes (PVCs). This study was aimed to determine autonomic nervous system (ANS) activity in patients with low, medium and high PVC burdens pre- and pro-RFCA. Methods We retrospectively analyzed a total of 200 patients underwent radiofrequency ablation surgery for idiopathic PVCS from June 2017 to March 2021. The procedural ablation success was achieved in 179 of the 200 (89.5%). Patients had success ablation was classified into low burden PVC group (PVCs/min ≤15%), medium burden PVC group (15%> PVCs/min <25%) and high burden PVC group (PVCs/min ≥25%). We assessed the clinical data, time and frequency-domain variables, heart rate turbulence(HRV) and deceleration capacity of rate of patients with different PVC burdens and various ablation site. Spearman correlation analysis was performed.Results High burden PVCs had higher mean HR, SDANN, SDNN index, standard deviation of normal to normal intervals (SDNN), root-mean square successive differences (rMSSD), pNN50 and lower ratio of low-frequency (LF)/ high-frequency (HF), compared to low burden PVCs. After ablation, SDNN, SDNN index, SDANN, rMSSD, pNN50, TS (turbulence slope) and DC (deceleration capacity) were significantly decreased (P<0.01), while LF/HF and TO was significantly increased (P<0.01). The burden of preoperative PVCs was positively correlated with LVD, mean HR, SDNN index, SDANN, rMSSD and pNN50, but negatively correlated with TC, LDL-C, LVEF and LF/HF. Regression analysis showed that the burden of PVCs was positively correlated with mean HR (P=0.000), SDANN (P=0.000) and rMSSD (P=0.000).Conclusion With the increase of PVCS burden, both sympathetic and vagus nerve activities are enhanced. The numbers of PVCS may be related to impaired autonomic nerve balance regulation. RFCA reduced parasympathetic activity and sympathetic activity after eradication of PVCS.