Fractal complexity alternations in paroxysmal atrial fibrillation patients with and without recurrence after pulmonary vein isolation

Ting Wei Ernie Liao, Cheng Hung Li, Yenn Jiang Lin, Shih Lin Chang, Yu Feng Hu, Fa Po Chung, Tze Fan Chao, Jo Nan Liao, Hui Wen Yang, Men Tzung Lo, Shih Ann Chen*, Li Wei Lo*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Pulmonary vein isolation (PVI) is a cornerstone therapy for paroxysmal atrial fibrillation (PAF). The variations in nonlinear heart rate variability (HRV) between patients with and without recurrences remain unclear. We aimed to characterize the nonlinear HRV before and after PVI in patients with and without recurrence. Methods: Twenty-five drug-refractory PAF patients (56.0 ± 9.1 years old, 20 males) who received PVI were enrolled. Holter electrocardiography were performed before, 1–3, and 6–12 months after PVI. After 8.2 ± 2.5 months of follow-ups after PVI, patients were divided into two groups: the recurrence (n = 8) and non-recurrence (n = 17) groups. Linear and nonlinear HRV variables were analyzed, including the Poincaré Plot analysis and the Detrended Fluctuation Analysis (DFA). Results: The non-recurrence group, but not the recurrence group, had decreased high-frequency component (HF), the root mean square of successive RR interval differences (RMSSD), and the Poincaré Plot index SD1 1–3 months after PVI and increased DFAslope2 6–12 months after PVI. The non-recurrence group's LF/HF ratio and DFAslope1 decreased significantly 1–3 and 6–12 months after PVI, respectively, whereas there was no significant change in the recurrence group after PVI. Conclusions: Significantly reduced vagal tone 1–3 months after PVI, increased long-term fractal complexity 6–12 months after PVI, and decreased sympathetic tone as well as short-term fractal complexity 1–3 and 6–12 months after PVI led to a better AF-free survival after PVI. These findings suggest that neuromodulation and heart rate dynamics play crucial roles in AF recurrence following PVI.

Original languageEnglish
Article numbere13074
JournalAnnals of Noninvasive Electrocardiology
Issue number5
StatePublished - Sep 2023


  • Poincaré plot analysis
  • atrial fibrillation
  • detrended fluctuation analysis
  • heart rate variability
  • nonlinear heart rate variability


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