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A low fibrillatory wave amplitude predicts sinus node dysfunction after catheter ablation in patients with persistent atrial fibrillation

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Abstract

Background

Concealed sinus node dysfunction (SND) may become manifest after restoration of sinus rhythm by ablation in patients with persistent atrial fibrillation (AF). The purpose of this study was to investigate the predictors of SND after catheter ablation of persistent AF.

Methods

Two hundred two consecutive patients who underwent ablation for persistent AF were enrolled. Ipsilateral pulmonary vein isolation followed by, if necessary, electrical cardioversion were performed in all patients. SND was defined when temporary and/or permanent pacemakers were needed due to sinus bradycardia after ablation.

Results

SND developed in 12 (5.9 %) patients. There was no difference between the patients with and without SND in terms of the age (with SND, 67 ± 9 and without, 66 ± 10 years old, P = 0.599) and sex (male; 58 vs. 79 %, P = 0.186). However, the patients with SND had a lower amplitude of the fibrillatory waves (0.115 ± 0.086 vs. 0.176 ± 0.077 mV, P = 0.009) and larger left atrial volume index (LAVI; 66 ± 31 vs. 34 ± 13, P = 0.007) than those without. A receiver operating characteristic curve identified a fibrillatory wave amplitude of 0.145 mV (AUC = 0.742; sensitivity = 65 %; specificity = 83 %) and LAVI of 47.5 ml/m2 (AUC = 0.837; sensitivity = 82 %; specificity = 87 %) as the optimal cutoff values for predicting SND. A multivariate analysis revealed that the amplitude of the fibrillatory waves (odds ratio = 0.84 for 0.010 mV increase, 95 % CI = 0.71–0.98, P = 0.031) and LAVI (odds ratio = 1.08 for 1.0 cm3/m2 increase, 95 % CI = 1.04–1.12, P < 0.001) were independent risk factors for SND.

Conclusions

A low amplitude of the fibrillatory waves and a large LAVI were predictors of SND after restoration of sinus rhythm by ablation in patients with persistent AF.

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Funding

This study was not supported by any funding source.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Kansai Rosai Hospital Cardiovascular Center, 3-1-69, Inabaso, Amagasakishi, Hyogo, 660-8511, Japan

    Akihiro Sunaga, Masaharu Masuda, Takashi Kanda, Masashi Fujita, Osamu Iida, Shin Okamoto, Takayuki Ishihara, Yasuhiro Matsuda & Masaaki Uematsu

  2. Department of Cardiology, Yao Municipal Hospital, 1-3-1, Ryugetyo, Yaoshi, Osaka, Japan

    Tetsuya Watanabe

  3. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 1-1, Yamadaoka, Suita-shi, Osaka, Japan

    Yasushi Sakata

Authors
  1. Akihiro Sunaga
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  2. Masaharu Masuda
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  3. Takashi Kanda
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  4. Masashi Fujita
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  5. Osamu Iida
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  6. Shin Okamoto
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  7. Takayuki Ishihara
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  8. Yasuhiro Matsuda
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  9. Tetsuya Watanabe
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  10. Yasushi Sakata
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  11. Masaaki Uematsu
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Corresponding authors

Correspondence to Akihiro Sunaga or Masaharu Masuda.

Additional information

What’s New

1. A low amplitude of the fibrillatory waves predicted sinus node dysfunction after catheter ablation in patients with persistent atrial fibrillation.

2. A large left atrial volume index predicted sinus node dysfunction after catheter ablation in patients with persistent atrial fibrillation.

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Sunaga, A., Masuda, M., Kanda, T. et al. A low fibrillatory wave amplitude predicts sinus node dysfunction after catheter ablation in patients with persistent atrial fibrillation. J Interv Card Electrophysiol 43, 253–261 (2015). https://doi.org/10.1007/s10840-015-0017-1

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  • DOI: https://doi.org/10.1007/s10840-015-0017-1

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