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Impact of nocturnal blood pressure dipping on recurrence of atrial fibrillation after pulmonary vein isolation

Hypertension Research (2024)Cite this article

Abstract

Lack of the typical nocturnal blood pressure (BP) fall, i.e non-dipper, has been known as a cardiovascular risk. However, the influence of non-dipper on atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been unclear. We investigated the clinical impact of non-dipping as evaluated by 24-hour ambulatory BP monitoring on the long-term outcome of AF recurrence post-PVI in 76 AF patients with a history of increased BP. The PVI procedure was successful in all 76 patients (mean age, 66±9years; antihypertensive medication, 89%; non-paroxysmal AF, 24%). Twenty patients had AF recurrence during a median follow-up of 1138 days. There was no difference in BP levels between the AF recurrence and non-recurrence groups (average 24 h systolic BP:126 ± 17 vs.125 ± 14 mmHg; P = 0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs.15.0%; P = 0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF and average 24-hr systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI:1.05–7.34], P = 0.039). Non-dipper patients had a larger left atrial (LA) volume index than the dipper patients (45.9 ± 17.3 vs.38.3 ± 10.2 ml/m2, P = 0.037). Among the 58 patients who underwent high-density voltage mapping in LA, 11 patients had a low-voltage area (LVA) defined as an area with a bipolar voltage < 0.5 mV. However, there was no association of LVA with non-dipper or dipper (22.2% vs.16.1%, P = 0.555). Non-dipper is an independent predictor of AF recurrence post-PVI. Management of abnormal diurnal BP variation post-PVI may be important.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

    Tomonori Watanabe, Satoshi Hoshide, Hitoshi Hachiya, Yoshiyuki Yumita, Masafumi Sato, Tadayuki Mitama, Takafumi Okuyama, Hiroaki Watanabe, Ayako Yokota, Masashi Kamioka, Takahiro Komori, Hisaki Makimoto, Tomoyuki Kabutoya, Yasushi Imai & Kazuomi Kario

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  1. Tomonori Watanabe
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Tomonori Watanabe MD, Satoshi Hoshide MD, Hitoshi Hachiya MD, Yoshiyuki Yumita MD, Masafumi Sato MD, Tadayuki Mitama MD, Takafumi Okuyama MD, Hiroaki Watanabe MD, Ayako Yokota MD, Masashi Kamioka MD, Takahiro Komori MD, Hisaki Makimoto MD, Tomoyuki Kabutoya MD, Yasushi Imai MD and Kazuomi Kario MD. All authors contributed to the study concept, design, data analysis and statistical interpretation, and drafting and revision of the article. All approved of the final article.

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Correspondence to Tomonori Watanabe.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All patients gave their written informed consent. The study protocol was approved by the hospital’s institutional ethics review board. This study conformed to the guidelines outlined in the Declaration of Helsinki.

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Watanabe, T., Hoshide, S., Hachiya, H. et al. Impact of nocturnal blood pressure dipping on recurrence of atrial fibrillation after pulmonary vein isolation. Hypertens Res (2024). https://doi.org/10.1038/s41440-024-01645-3

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