Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy
- 250 Downloads
Thyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known.
This study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation. A total of 146 patients on THR and 146 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model (age, sex, body mass index, and left atrium size). The presence of non-pulmonary vein (PV) triggers was disclosed by a high-dose isoproterenol challenge (up to 30 μg/min) after PV isolation.
Clinical characteristics were not different between the groups. When compared to the control, non-PV triggers were significantly greater in the THR patients [112 (77%) vs. 47 (32%), P < 0.001], and most frequently originated from the right atrium (95 vs. 56%, P < 0.001). Other sources of non-PV triggers were the interatrial septum (25 vs. 11%, P = 0.002), coronary sinus (70 vs. 52%, P = 0.01), left atrial appendage (47 vs. 34%, P = 0.03), crista terminalis/superior vena cava (11 vs. 8%, P = 0.43), and mitral valve annulus (7 vs. 5%, P = 0.45) (THR vs. control), respectively. After mean follow-up of 14.7 ± 5.2 months, success rate was lower in patients on THR therapy [94 (64.4%)] compared to patients not receiving THR therapy [110 (75.3%), log-rank test value = 0.04].
Right atrial non-PV triggers were more prevalent in AF patients treated with THR. Elimination of non-PV triggers provided better arrhythmia-free survival in the non-THR group.
KeywordsAtrial fibrillation Catheter ablation Thyroid hormone
Compliance with ethical standards
Conflict of interest
Dr. Natale received speaker honorariums from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik and Medtronic; Dr. Natale is a consultant for Biosense Webster St Jude Medical and Janssen. Dr Burkhardt is a consultant for Biosense-Webster and Stereotaxis.
Dr. Di Biase is a consultant for Biosense Webster, Stereotaxis and St Jude Medical. Dr. Di Biase received speaker honoraria/travel from Medtronic, EPiEP, Janssen, Pfizer, Bristol Meyers, Boston Scientific and Biotronik.
Other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
All patients who underwent catheter ablation provided written informed consent before the procedure.The outcome data was extracted from our prospective AFib registry, which is Institutional Review Board (IRB)-approved.
- 1.Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M: . Thyroid Res 2009; 2:4-6614-2-4Google Scholar
- 7.Mohanty S, Mohanty P, Trivedi C, Gianni C, Bai R, Burkhardt JD, et al. Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction. Heart Rhythm. 2015;12:1963–71.CrossRefPubMedGoogle Scholar
- 9.Chaker L, Heeringa J, Dehghan A, Medici M, Visser WE, Baumgartner C, Hofman A, Rodondi N, Peeters RP, Franco OH: Normal thyroid function and the risk of atrial fibrillation: the Rotterdam study. J Clin Endocrinol Metab 2015:jc20152480Google Scholar
- 16.Sairaku A, Nakano Y, Uchimura Y, Tokuyama T, Kawazoe H, Watanabe Y, Matsumura H, Kihara Y. Increased left atrial pressure in non-heart failure patients with subclinical hypothyroidism and atrial fibrillation. Endocr Connect. 2016.Google Scholar
- 17.Kolettis TM, Tsatsoulis A. Subclinical hypothyroidism: an overlooked cause of atrial fibrillation? JAFIB. 2013;5(4):6–8.Google Scholar
- 19.Santangeli P, Di Biase L, Natale A. Ablation versus drugs: what is the best first-line therapy for paroxysmal atrial fibrillation? Antiarrhythmic drugs are outmoded and catheter ablation should be the first-line option for all patients with paroxysmal atrial fibrillation: pro. Circ Arrhythm Electrophysiol. 2014;7:739–46.CrossRefPubMedGoogle Scholar
- 21.Mohanty S, Natale A, Mohanty P, DI Biase L, Trivedi C, Santangeli P, et al. Pulmonary vein isolation to reduce future risk of atrial fibrillation in patients undergoing typical flutter ablation: results from a randomized pilot study (REDUCE AF). J Cardiovasc Electrophysiol. 2015;26:819–825l.CrossRefPubMedGoogle Scholar
- 23.Bai R, di Biase L, Mohanty P, Santangeli P, Mohanty S, Pump A, et al. Catheter ablation of atrial fibrillation in patients with mechanical mitral valve: long-term outcome of single procedure of pulmonary vein antrum isolation with or without nonpulmonary vein trigger ablation. J Cardiovasc Electrophysiol. 2014;25:824–33.CrossRefPubMedGoogle Scholar
- 25.Gokoglan Y, Mohanty S, Gunes MF, Trivedi C, Santangeli P, Gianni C, Asfour I, Bai R, Burkhardt JD, Horton R, Sanchez J, Hao S, Hongo R, Beheiry S, Di Biase L, Natale A. Pulmonary vein antrum isolation in patients with paroxysmal atrial fibrillation: more than a decade of follow-up. Circ Arrhythm Electrophysiol. 2016 9(5) doi: 10.1161/CIRCEP.115.003660
- 28.Sauer WH, Alonso C, McKernan M, et al. Female gender is associated with the presence of nonpulmonary vein triggers of atrial fibrillation (abstr). Circulation. 2003;108 Suppl 5:617.Google Scholar
- 29.Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988–1028.CrossRefPubMedGoogle Scholar