Low resting heart rate is associated with recurrence in persistent atrial fibrillation after catheter ablation

Background: Resting heart rate (RHR)is critical for identifying high-risk patients with atrial fibrillation (AF). However, the association between resting heart rate (RHR) and AF recurrence after catheter ablation remains unknown. Objective: This study was to evaluate the association between RHR and recurrence in patients with persistent atrial fibrillation (PeAF) after catheter ablation. Methods: Data from the China-AF registry (ChiCTR-OCH-13003729) from January 2018 to December 2023 at Beijing Anzhen Hospital were retrospectively analyzed. The primary outcome was the recurrence of AF, defined as an episode of atrial tachyarrhythmia lasting >30 seconds after a 3-month blanking period. The secondary outcome was the composite of heart failure, ischemic stroke, and cardiovascular death. Cox regression was used to assess the association between RHR and outcomes. Results: Our study included 2,432 patients with PeAF undergoing catheter ablation. Cox regression demonstrated that RHR of 40-60 bpm was associated with an increased risk of recurrence after adjusting the confounders (HR=2.08, 95% CI:1.16-3.74, P= 0.014). Additionally, we showed that patients with low RHR (40-60 bpm) had a higher risk of the composite of heart failure, ischemic stroke, and cardiovascular death (HR=11.69, 95% CI:3.01-45.43, P< 0.001). Conclusion: Low RHR is associated with recurrence in PeAF after catheter ablation, where RHR of 40-60 bpm exhibits a higher risk.