Association Between Periprocedural Heart Rate Trend and Postprocedural Worsening Heart Failure in Patients Receiving Catheter Ablation for Atrial Fibrillation - Reply.

spective study. As Drs. Kataoka and Imamura note, the optimal heart rate in atrial fibrillation (AF) patients is unclear, and a few patients in our study had bradyarrhythmia that required pacemaker implantation. However, as discussed in the paper, sinus node dysfunction is found in AF patients.4 In such patients, the heart rate tended to decrease under the influence of sedation during the procedure,5 and a failure of cardiac function to adapt to the decrease in heart rate may cause DHF. In the case of a decrease in heart rate after catheter ablation, patients should be closely observed, and, when pulmonary congestion is found on chest X-rays or elevated intracardiac pressure is found on echocardiography, early interventions to prevent DHF, such as the administration of diuretics and/or nitrates, should be considered. If a considerable decrease in heart rate occurs, prevention of bradycardia by temporary cardiac pacing may be also considered as optional therapy.