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Atrial involvement and progression of sinus node dysfunction in non-senile patients: evidences from electroanatomic mapping and long-term follow-up

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Abstract

Purpose

Sinus node inability or conduction disorders of its surrounding atrial myocardium cause sinus node dysfunction (SND). This study aimed to characterize right atrium (RA) substrates and long-term atrial lead performance after pacemaker implantation in non-senile SND patients.

Methods

Eighteen SND patients (53.3 ± 9.6 years) controlled by 18 age-matched supraventricular tachycardia patients were consecutively enrolled. The P-wave amplitude (PWA) and P-wave duration (PWD) were measured on surface electrocardiography. Electroanatomic mapping was conducted to assess the bipolar voltage, complex signals, volume, and activation time of RA. Pacemaker implantation was performed in SND patients after mapping.

Results

Compared with controls, SND patients showed significant PWA reduction (0.13 ± 0.02 vs. 0.16 ± 0.04 mV, p = 0.017) and PWD prolongation (120.8 ± 15.2 vs. 105.2 ± 8.6 ms, p = 0.001). The RA endocardial voltage was lower (1.56 ± 0.78 vs. 2.57 ± 0.55 mV, p < 0.001) and activation time was longer (112.1 ± 14.9 vs. 90.8 ± 12.4 ms, p < 0.001) in the study group. Atrial lead was anchored at the lower atrial septum in one patient and failed in another due to extensive atrial scarring. During a median follow-up of 86 (57–88) months, one patient lost atrial capturing, and overall atrial sensing was significantly decreased (2.44 ± 1.16 vs. 1.87 ± 1.01 mV, p = 0.003).

Conclusions

Atrial involvement was proved and the process was progressive in non-senile SND patients, as demonstrated by diffused RA lower voltage, slower conduction, and the decrease of the atrial lead sensing.

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Funding

This work was supported by the National Natural Science Foundation of China (81870252) and the Natural Science Foundation of Jiangsu Province (BK20181495).

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Author notes

  1. Chengzong Li and Weizhu Ju contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300#, Guangzhou Road, Nanjing, 210029, China

    Chengzong Li, Weizhu Ju, Kai Gu, Mingfang Li, Chang Cui, Hailei Liu, Zidun Wang, Hongwu Chen, Gang Yang, Fengxiang Zhang, Bing Yang & Minglong Chen

  2. Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, China

    Chengzong Li & Zhirong Wang

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  1. Chengzong Li
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  2. Weizhu Ju
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  13. Minglong Chen
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Corresponding author

Correspondence to Minglong Chen.

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Ethical approval

The study was approved by the ethics committee of The First Affiliated Hospital of Nanjing Medical University.

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All patients provided written informed consent before the procedure.

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The authors declare that they have no conflict of interest.

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Li, C., Ju, W., Gu, K. et al. Atrial involvement and progression of sinus node dysfunction in non-senile patients: evidences from electroanatomic mapping and long-term follow-up. J Interv Card Electrophysiol 60, 365–373 (2021). https://doi.org/10.1007/s10840-020-00735-9

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  • DOI: https://doi.org/10.1007/s10840-020-00735-9

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