Higher very short-term blood pressure variability is associated with lower atrial fibrillation recurrence after catheter ablation

Background Blood pressure variability (BPV) is a cardiovascular risk marker independent of mean blood pressure. Prior studies have suggested potential associations between BPV and atrial fibrillation (AF) recurrence, but the relevance of very short-term, beat-to-beat BPV remains uncertain. Methods In this single-center retrospective cohort study, we enrolled 153 consecutive patients undergoing first-time AF ablation who underwent pre-procedural overnight polygraphy with simultaneous pulse transit time-based beat-to-beat blood pressure monitoring. Very short-term BPV was quantified as the standard deviation (SD) of nighttime beat-to-beat systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP); patients were dichotomized at the median. The primary endpoint was the first recurrence of AF lasting ≥ 30s beyond a 3-month blanking period during 12 months of follow-up. Results During follow-up, AF recurrence occurred in 15 patients (9.8%). Kaplan–Meier curves showed significantly lower recurrence rates in the higher BPV groups (SD of SBP: P = 0.015; SD of DBP: P = 0.002; and SD of MBP: P = 0.003). In univariable Cox proportional hazards models, higher BPV was associated with lower recurrence risk (SD of SBP: hazard ratio 0.519, 95% confidence interval 0.311–0.865; SD of DBP: hazard ratio 0.258, 95% confidence interval 0.101–0.664; and SD of MBP: hazard ratio 0.251, 95% confidence interval 0.099–0.638). Conclusion Higher nighttime very short-term BPV was associated with lower AF recurrence after first-time ablation. Pulse transit time-based cuffless monitoring may provide a practical method for preprocedural risk stratification; confirmation via multicenter studies is warranted.