Nocturnal blood pressure pattern on ambulatory blood pressure monitoring and recurrence after pulmonary vein isolation for atrial fibrillation.

BACKGROUND

Nocturnal blood pressure patterns reflect autonomic and volume-related stress and may affect outcomes after pulmonary vein isolation (PVI). We examined their association with atrial fibrillation recurrence after PVI using ambulatory blood pressure monitoring (ABPM).

METHODS AND

RESULTS

We retrospectively studied 74 consecutive patients with preprocedural ABPM. Patients were classified as dipper (≥10% nocturnal systolic blood pressure decline), nondipper (0 to <10%), or riser (nighttime > daytime blood pressure). Recurrence was defined as any documented atrial tachyarrhythmia lasting greater than or equal to 30 s after the 90-day blanking period; episodes beginning during blanking and persisting beyond day 90 were assigned to day 90. Recurrence occurred in 27 patients (36.5%). Pattern distribution differed significantly by recurrence status (P = 0.002), with recurrence rates of 26.1% in dippers, 31.0% in nondippers, and 88.9% in risers. Kaplan-Meier analysis showed significantly lower freedom from recurrence in risers (log-rank P < 0.001). In univariable Cox analysis using dippers as the reference, risers were associated with recurrence (hazard ratio: 9.50, 95% confidence interval: 3.22-27.97; P < 0.001), whereas nondippers were not. In an exploratory multivariable model including nocturnal blood pressure pattern, persistent atrial fibrillation, and age, the riser pattern remained associated with recurrence (hazard ratio: 9.53, 95% confidence interval: 3.00-30.29; P < 0.001).

CONCLUSION

The riser pattern on ABPM was associated with early postblanking recurrence after PVI and may provide complementary information for risk stratification.