Prolonged PR Interval and Risk of Recurrence of Atrial Fibrillation After Catheter Ablation

Wu, Jintao; Dong, Jianzeng; Sang, Caihua; Tang, Ri‐Bo; Ma, Changsheng

doi:10.1536/ihj.13-231

Cited by 15 publications

(13 citation statements)

References 34 publications

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“…Several work groups found a close connection between prolonged PR interval using the clinical definition of first-degree AVB (PR >200 ms) and incidence of AF as well as other adverse cardiovascular outcomes like stroke, heart failure and dementia causing an increased mortality [ 3 , 4 , 13 ]. Besides the association between PR interval prolongation with onset of AF [ 5 ], higher recurrence rates after catheter ablation were described [ 6 , 14 ]. However, there are also studies that could not show an association between prolonged PR interval and AF [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Association between PR interval prolongation and electro-anatomical substrate in patients with atrial fibrillation

et al. 2018

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BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in clinical routine. Left atrial (LA) electro-anatomical remodelling in AF patients indicates disease progression and is associated with poor therapeutic success. PR interval prolongation is associated with an increased risk for AF, however, the association between LA remodelling measured as low voltage areas (LVA) during catheter ablation and PR interval is unknown. The aim of this study was to investigate the association between PR interval prolongation and LVA in AF patients.MethodsWe studied 103 patients (62±12 years, 59% males, 34% persistent AF) undergoing first AF catheter ablation and presenting with sinus rhythm. PR interval prolongation was defined as PR >200ms and analysed in resting ECG before intervention. LVA were determined using high-density maps and defined as <0.5 mV.ResultsThere were 24 patients (23%) with PR interval prolongation and 18 patients (17%) with LVA. There were significant correlations between PR prolongation with LVA, CHA2DS2-VASc score and eGFR (r2 = 0.230, 0.216, and 0.307, all p<0.05). PR interval prolongation (OR 3.450, p = 0.024), persistent AF (OR 5.391, p = 0.002), and LA size (OR 1.117, p = 0.018) were significant predictors for LVA, while age (OR 1.072, p = 0.005), LVA (OR 3.450 p = 0.024) and eGFR (OR 0.962, p = 0.004) were associated with PR interval prolongation.ConclusionsBeside persistent AF and LA size, PR interval prolongation might be useful for the prediction of electro-anatomical substrate in AF patients. Larger studies are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Association between PR interval prolongation and electro-anatomical substrate in patients with atrial fibrillation

et al. 2018

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“…Under such physical or mental condition, conducting V-pacing because of DDDR (CLS)-mode with rate-dependent stepwiseshortening AV sequence, rather than preventing V-pacing, might have effectively reduced the atrial overload and improved the atrial vulnerability to AF exclusively during rapid pacing over 90 bpm in our case. Other population-based studies conducted under the condition of ambulatory daily life have shown that a PQ interval longer than 200 ms was associated with development of AF, [12][13][14] which also suggested that extreme AV prolongation along with diastolic mitral regurgitation might have resulted in atrial overload and be associated with atrial vulnerability to PAF.…”

Section: Discussionmentioning

confidence: 93%

Effective Management of Atrioventricular Interval for Paroxysmal Atrial Fibrillation That Developed After DDDR Pacemaker Implantation in a Sick Sinus Syndrome Patient

et al. 2015

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SummaryA 68-year-old man with sick sinus syndrome (SSS) was referred to our department for pacemaker implantation. After implantation of a pacemaker with rate-responsive dual chamber (DDDR) mode and minimized ventricular pacing (MVP) functions, paroxysmal atrial fibrillation (PAF) repeatedly developed. Pacemaker memory showed that the intrinsic atrioventricular (AV) (atrial pacing-ventricular sensing [Ap-Vs]) interval was paradoxically prolonged during rate-responsive atrial single-chamber (AAIR) mode rapid pacing because of MVP. Accordingly, to eliminate the paradoxical prolongation of the AV interval during rapid atrial pacing, we changed MVP to medium AV hysteresis and conducted DDDR mode pacing with rate-dependent AV delay. PAF then sharply decreased without antiarrhythmic drugs. ( 1-7) However, there are few detailed reports concerning the effective management of atrioventricular (AV) interval for suppression of PAF which develops after implantation of a DDD pacemaker (PM) with the current standard functions of rate-response and MVP.We implanted a DDD PM in an SSS patient and subsequently implemented the functions of rate-response and MVP at the same time. PAF then repeatedly developed after discharge. To suppress the PAF, we changed MVP to medium AV hysteresis and activated rate-dependent (Dynamic ® ) AV delay, while preserving the rate-response function. Thereafter, the repeated PAF sharply decreased without antiarrhythmic drugs or any additional therapy. We describe here the detailed clinical course of PAF, including PM memory, and assess the mechanism in this patient. Case ReportA 68-year-old man had been previously diagnosed with hypertension, sleep apnea syndrome, cardiomegaly, and sinus bradycardia. At the end of June 2010, he experienced syncope for the first time, when long pauses occurred during Holter monitoring which was performed to examine sinus bradycardia. Holter recording showed the development of PAF and consecutive pauses of 5.5, 3.5, and 3.45 seconds on its termination. In early July, he was admitted to our hospital for PMI with the diagnosis of SSS. Examination findings on admission were as follows: sinus bradycardia was 41 beats per minute (bpm) and the PQ interval was 150 milliseconds (ms) on a 12-lead electrocardiogram (ECG); the cardiothoracic ratio was 57% on chest X-ray; left atrial dimension (LAD) was 57 mm, left ventricular diastolic dimension was 59 mm, left ventricular ejection faction was 75% on echocardiogram; and the serum B-type natriuretic peptide (BNP) level was 142.9 pg/mL.In the middle of July, a DDD-mode PM (Entovis DR-T, Biotronik, Berlin, Germany) with 180 ms of AV delay on 60 bpm of lower-rate pacing was implanted (Figure 1). Leads were placed in the right atrial appendage and ventricular apex. Rate-dependent (Dynamic) AV delay was started on the date of PMI, although the function was virtually invalid because of DDD-mode back-up pacing with 180 ms of AV delay ( Figure 1).From the

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“…20,21) Although many patients with late recurrence after PAF ablation had reconnected PVs, a smaller percentage of patients undergoing repeat procedures for AF recurrence were found to have non-PV foci that may not have been identified or targeted during the initial procedure. 22) About 4% to 42% of patients having repeat ablation procedures for paroxysmal AF need ablation of non-PV foci during the follow-up procedure.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Empiric Isolation and Conventional Isolation of Superior Vena Cava in Addition to Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation

Li¹,

Jiang

Zhong³

et al. 2017

Int. Heart J.

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SummaryRadiofrequency catheter ablation (RFCA) in the treatment of AF is currently based on pulmonary vein isolation (PVI). Some studies have investigated the efficacy of empiric SVC isolation (SVCI) in addition to conventional PVI in order to improve success rates and reduce recurrence rates. However, the results of the studies have given conflicting data.We performed a meta-analysis to evaluate the efficacy and safety of the empiric SVCI compared with conventional SVCI for paroxysmal atrial fibrillation (PAF) ablation.We searched MEDLINE, EMBASE, the Web of Science, and the Cochrane Database from the period January 1986 to August 2016 and identified qualified studies. The primary clinical outcome was the recurrence rate of atrial tachyarrhythmias, and the secondary clinical outcomes were procedure time, fluoroscopy time, and complications.We identified 3 randomized controlled trials (RCTs) and one nonrandomized, observational study (nROS) involving 245 patients with empiric SVCI and 269 patients with conventional SVCI. The empiric SVCI group had a lower recurrence rate of atrial tachyarrhythmia after a single procedure compared with the conventional SVCI group (16.7% versus 29.4%, OR: 0.48, 95%CI: 0.31 to 0.74, P = 0.0009). There was no significant difference in fluoroscopic time (P = 0.22), procedure time (P = 0.32), or clinical complications (P = 0.33) between the two groups.Empiric SVCI is more effective than conventional SVCI in terms of the long-term outcomes of PAF patients after a single PVI procedure, with the same fluoroscopic time, procedure time, and clinical complications. (Int Heart J 2017; 58: 500-505) Key words: Arrhythmia, Pulmonary vein, Atrial fibrillation, Meta R adiofrequency catheter ablation (RFCA) is an effective treatment option for patients with atrial fibrillation (AF). At present, RFCA in the treatment of AF is based on pulmonary vein isolation (PVI), whether it is segmental PVI or circumferential PVI.1,2) AF can be also initiated by nonpulmonary vein ectopic beats such as in the superior vena cava (SVC), coronary sinus ostium, left atrial posterior wall, crista terminalis, and ligament of Marshall.3) Despite initial positive results of the PVI strategy, RFCA that targeted the pulmonary vein alone showed a significant recurrence rate after the first procedure with the reconnection of the pulmonary vein or with the emergence of non-PV ectopic foci including the SVC.3-5) Some researchers have investigated the efficacy of empiric SVC isolation (SVCI) in addition to conventional SVCI (performing SVCI only for patients who have triggers in the SVC) 6) in order to improve success rates and reduce recurrence rates in patients with AF. 7-9) However, some studies also have provided conflicting data indicating that there was no statistical significance for these two strategies after the initial AF ablation.10,11) Therefore, we believed a meta-analysis of published data was needed to assess the efficacy of empiric isolation and conventional isolation of SVC in patients with paroxysmal AF (PAF).

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Prolonged PR Interval and Risk of Recurrence of Atrial Fibrillation After Catheter Ablation

Cited by 15 publications

References 34 publications

Association between PR interval prolongation and electro-anatomical substrate in patients with atrial fibrillation

Association between PR interval prolongation and electro-anatomical substrate in patients with atrial fibrillation

Effective Management of Atrioventricular Interval for Paroxysmal Atrial Fibrillation That Developed After DDDR Pacemaker Implantation in a Sick Sinus Syndrome Patient

Comparison of Empiric Isolation and Conventional Isolation of Superior Vena Cava in Addition to Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation

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