Sinus node dysfunction characterized by reduction only in maximum heart rate during exercise after superior vena cava isolation in atrial fibrillation catheter ablation—A potential complication

Hayashi, Tatsuya; Mizukami, Akira; Kuroda, Shunsuke; Matsumura, Akihiko; Goya, Masahiko; Sasano, Tetsuo

doi:10.1016/j.hrcr.2019.12.012

Cited by 3 publications

(3 citation statements)

References 14 publications

(15 reference statements)

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“…[22][23][24] These characteristics might be attributed to a higher e-SAN location in those with a higher HR. That is, the 6 This implies that there are cases in which the potential complications of SAN injury are overlooked.…”

Section: Discussionmentioning

confidence: 99%

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An anatomical approach to determine the location of the sinoatrial node during catheter ablation

Shimamoto

Yamagata

Nakajima

et al. 2021

Cardiovasc electrophysiol

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Introduction: The sinoatrial node (SAN) should be identified before superior vena cava (SVC) isolation to avoid SAN injury. However, its location cannot be identified without restoring sinus rhythm. This study evaluated the usefulness of the anatomically defined SAN by comparing it with the electrically confirmed SAN (e-SAN) to predict the top-most position of e-SAN and thus establish a safe and more efficient anatomical reference for SVC isolation than the previously reported reference of the right superior pulmonary vein (RSPV) roof. Methods and Results:The e-SAN was identified as the earliest activation site in the electroanatomical map obtained during sinus rhythm. The anatomically defined SAN, the cranial edge of the crista terminalis (CT) visualized with intracardiac echocardiography (CT top), and the RSPV roof, which was obtained from the overlaid electroanatomical image of SVC and RSPV, were tagged on one map.The distance from the e-SAN to each reference was measured. Among 77 patients, the height of the e-SAN from the CT top was a median (interquartile range) of −2.0 (−8.0 to 4.0) mm. The e-SAN existed from 10 mm above the CT top or lower in 74 (96%) patients and from the RSPV roof or below in 73 (95%) patients. The reference of 10 mm above the CT top is more proximal to the right atrium than the RSPV roof and can provide longer isolatable SVC sleeves (30.0 [20.0-35.0] vs. 24.0 [18.0-30.0] mm, p < .001). The e-SAN tended to be found above the CT top when the heart rate during mapping was faster (adjusted odds ratio [95% confidence interval] per 10-bpm increase: 1.71 [1.20−2.43], p < .01). Conclusion:The CT top is useful for predicting the upper limit of the e-SAN and can provide a better reference for SVC isolation than the RSPV roof.

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Section: Discussionmentioning

confidence: 99%

“…However, e-SAN cannot always be detected before SVC isolation. 5,6 Therefore, an anatomical landmark indicating the location of the e-SAN can be a useful guide during SVC isolation procedures.…”

Section: Introductionmentioning

confidence: 99%

An anatomical approach to determine the location of the sinoatrial node during catheter ablation

Shimamoto

Yamagata

Nakajima

et al. 2021

Cardiovasc electrophysiol

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“…The second considered iatrogenic factor, as mentioned above, is the ablation procedure [27][28][29]. Clinically evident damage of coronary arteries during RFA for AF is rare and, according to a number of authors, is only about 0.09 % [53,54]. However, it can be associated with the development of acute SND, requiring pacemaker implantation.…”

Section: Iatrogenic (Associated With the Impact Of Antiarrhythmic Dru...mentioning

confidence: 99%

Association of atrial fibrillation and atrial flutter with sick sinus syndrome: a review of the issue based on examples of clinical observations

Schmidt¹,

Volkov

Брынза³

et al. 2022

ZMJ

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Despite significant progress in the treatment of patients with cardiac arrhythmias, atrial fibrillation (AF) remains one of the leading causes of serious cardiovascular events around the world. Currently, radiofrequency ablation (RFA) is the first-line method in the treatment of patients with AF. However, signs of sick sinus syndrome (SSS) are found in some AF patients after RFA, which requires urgent or planned pacemaker implantation. Aim. To review current therapies for AF and sick sinus syndrome (SSS) and analyze peculiarities of the SSS development after RFA for AF. Materials and methods. The analysis of the world literature data was carried out along with the analysis of our own clinical observations of patients with AF who underwent RFA. Results. As a result of the data analysis, it was proposed to identify three possible groups of causes why AF patients may develop SSS after RFA: 1) organic (associated with degenerative fibrosis of the sinus node tissue that occurs during aging, or with other underlying organic changes in the sinus node), 2) functional (associated with the remodeling of the sinus node tissue and the surrounding tissue of the atrial myocardium caused by prolonged AF persistence), 3) iatrogenic (associated with the effects of antiarrhythmic drugs on the sinus node or caused by the RFA itself). Each group of causes identified was illustrated by a clinical case with the following analysis of long-term results of RFA. Conclusions. It was proposed to develop a scale for SSS prediction in patients after RFA for AF evaluating a patient’s medical history, resting electrocardiography, 24-hour electrocardiographic monitoring, and, in some cases, coronary angiography to assess the peculiarities of the sinus node blood supply. The use of the above predictors could reduce the percentage of possible complications such as development of SSS in patients after RFA and also help to identify patients who may need a pacemaker implantation in the future.

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Notable Pacemaker Shift in the Sinoatrial Node After Administration of Isoproterenol

Iwasa

Okada²,

Tanaka³

et al. 2023

Canadian Journal of Cardiology

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Sinus node dysfunction characterized by reduction only in maximum heart rate during exercise after superior vena cava isolation in atrial fibrillation catheter ablation—A potential complication

Cited by 3 publications

References 14 publications

An anatomical approach to determine the location of the sinoatrial node during catheter ablation

An anatomical approach to determine the location of the sinoatrial node during catheter ablation

Association of atrial fibrillation and atrial flutter with sick sinus syndrome: a review of the issue based on examples of clinical observations

Notable Pacemaker Shift in the Sinoatrial Node After Administration of Isoproterenol

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