Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

Abstract

SummaryAtrial electrical and structural remodeling is related to the perpetuation of atrial fibrillation (AF) subsequent to sinus node dysfunction. We investigated the relationship between AF recurrence after catheter ablation and sinus node dysfunction in long-standing persistent AF patients using the sinus node recovery time (SNRT) after defibrillation.Fifty-one consecutive patients who underwent a first ablation for long-standing persistent AF were enrolled. Intracardiac cardioversion was applied before ablation in the absence of any antiarrhythmic drugs, and the power required to defibrillate, number, and SNRT after defibrillation were measured. All patients underwent the same designed radiofrequency catheter ablation procedure.No patient required permanent pacemaker implantation due to sinus dysfunction after the ablation. During the follow-up period of 28.4 months (3.6-43.7), 35 out of 51 patients (69%) experienced an AF recurrence. The AF recurrence was significantly associated with an older age (60 ± 11 versus 52 ± 12 years in the nonrecurrence group, P = 0.0196), longer SNRT after defibrillation (1722 [1410-2656] versus 1295 [676-1651] msec, P = 0.0125), and larger left atrial (LA) volume (59 ± 25 versus 41 ± 15 mL, P = 0.0119). There were no significant differences in the AF duration, AF cycle length, and right and total atrial conduction times between the 2 groups. A longer SNRT after defibrillation (adjusted HR 2.13, 95%CI 1.16-3.71, P = 0.0152) and larger LA volume (adjusted HR 1.03, 95%CI 1.01-1.04, P = 0.0054) were independent predictors of AF recurrence after ablation.Assessment of the SNRT after defibrillation may help to predict a successful ablation in patients with longstanding persistent AF.(Int Heart J Advance Publication)

Impact of corrected sinus node recovery time in predicting recurrence in patients with paroxysmal atrial fibrillation

“…20 A study that used late gadolinium-enhanced magnetic resonance imaging to evaluate atrial fibrosis found that significant LA fibrosis was associated with clinically significant SND that required pacemaker implantation. 22 Furthermore, an investigation of 51 long-standing persistent patients who all underwent their first ablation, reported a recurrence rate of 69% during a 28.4-month follow-up period; 23 in this study, a longer SNRT and a larger LA volume were shown to be independent predictors of AF recurrence. The present study found that CSNRT and LAVI were independent risk factors for PAF recurrence.…”

Low-Level Vagus Nerve Stimulation Reverses Obstructive Sleep Apnea-Related Atrial Fibrillation by Ameliorating Sympathetic Hyperactivity and Atrial Myocyte Injury

“…SNRT, reflecting the function of the sinus node, became longer in an aging mouse model, in parallel with increasing AF inducibility (Luo et al, 2013). Clinical studies have also indicated that a longer SNRT is an indicator of AF recurrence after catheter ablation (Yamaguchi et al, 2018). Both animal and human studies have demonstrated that a lengthy AF duration could affect and diminish the function of the AV node, which would manifest in longer AH and HV intervals (Zhang and Mazgalev, 2012;Sairaku et al, 2016).…”

Adverse Clinical Events during Long-Term Follow-Up After Catheter Ablation of Atrial Fibrillation

“…The ablation protocol was performed as described previously. 11,12) All procedures were performed under conscious sedation with propofol and/or dexmedetomidine. During the procedure, the activated clotting time was kept above 300 seconds by heparin after the transseptal puncture.…”

“…An extensive encircling PVI was performed with a single or double circular catheter method, in which two 20-pole circular-shaped catheters (Lasso, Biosense Webster, Diamond Bar, CA, USA) were placed in the ipsilateral superior and inferior PVs. 11) The ablation catheters were 3.5-mm-tip irrigation catheters (NAVISTAR THERMOCOOL, Biosense Webster) or 4mm-tip irrigation catheters (Safire BLU Duo, St. Jude Medical, St. Paul, MN, USA). From October 2013, a 3.5mm-tip irrigation catheter incorporating contact force (SMART TOUCH, Biosense Webster) was used.…”