Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Hayashi, Kentarō; Fukunaga, Masato; Yamaji, Kyohei; An, Yoshimori; Nagashima, Michio; Hiroshima, Kenzo; Ohe, Masatsugu; Makihara, Yu; Yamashita, Kennosuke; Ando, Kenji; Iwabuchi, Masashi; Goya, Masahiko

doi:10.1253/circj.cj-15-1384

Cited by 21 publications

(21 citation statements)

References 29 publications

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“…Hayashi, et al found an interesting finding that paroxysmal AF patients clinically diagnosed with SSS had a significantly higher prevalence of nonpulmonary vein (non-PV) foci than those without SSS (25.9% versus 13.9%; P = 0.027). 11) In the multivariate analysis, congestive heart failure (HR, 13.7; 95% CI: 1.57-119; P = 0.02) and non-PV foci (HR, 5.75; 95% CI: 1.69-19.6; P = 0.005) were independent predictors of recurrence following AF ablation in the SSS group. Thus, the present study together with other reports suggested that a longer SNRT after the defibrillation in longstanding persistent AF patients may lead to AF recurrence after ablation, possibly due to multiple processes of a progressive electrophysiologic abnormality of the sinus node region, remodeled LA enlargement, and/or a high incidence of non-PV foci.…”

Section: Discussionmentioning

confidence: 87%

“…The parameters used in this study were noninvasive tools for predicting the entire atrial electrical and structural damage, and thus, could not have determined regional RA remodeling, possibly because of a limited remodeling area around the sinus node. Similarly, even though comparative results have been shown between paroxysmal patients with and without symptomatic SSS, 11) no significant association in terms of the LA diameters assessed by transthoracic echocardiography have been found. Importantly, we found that both LA volume enlargement and prolonged SNRT were independently associated with long-term AF recurrence after multivariate adjustment.…”

Section: Discussionmentioning

confidence: 88%

“…The association between the SNRT and female sex was supported by the clinical observation that SSS are more prevalent in woman than in men. 10,11) One possibility of the strong association between the SNRT and CV number or CV threshold was that a lot of energy flowed to the sinus node and induced great electric damage to the node, and thus resulted in a prolonged SNRT. However, AF recurrence was significantly associated with a long SNRT (1564 versus 1287 msec, P = 0.0190), even among the patients in whom a successful CV was achieved by a sin-SINUS NODE RECOVERY TIME PREDICTS AF RECURRENCE gle CV with a low energy of 15 joules, suggesting a sinus node substrate vulnerable to AF rather than the CV energy itself.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

et al. 2018

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SummaryAtrial electrical and structural remodeling is related to the perpetuation of atrial fibrillation (AF) subsequent to sinus node dysfunction. We investigated the relationship between AF recurrence after catheter ablation and sinus node dysfunction in long-standing persistent AF patients using the sinus node recovery time (SNRT) after defibrillation.Fifty-one consecutive patients who underwent a first ablation for long-standing persistent AF were enrolled. Intracardiac cardioversion was applied before ablation in the absence of any antiarrhythmic drugs, and the power required to defibrillate, number, and SNRT after defibrillation were measured. All patients underwent the same designed radiofrequency catheter ablation procedure.No patient required permanent pacemaker implantation due to sinus dysfunction after the ablation. During the follow-up period of 28.4 months (3.6-43.7), 35 out of 51 patients (69%) experienced an AF recurrence. The AF recurrence was significantly associated with an older age (60 ± 11 versus 52 ± 12 years in the nonrecurrence group, P = 0.0196), longer SNRT after defibrillation (1722 [1410-2656] versus 1295 [676-1651] msec, P = 0.0125), and larger left atrial (LA) volume (59 ± 25 versus 41 ± 15 mL, P = 0.0119). There were no significant differences in the AF duration, AF cycle length, and right and total atrial conduction times between the 2 groups. A longer SNRT after defibrillation (adjusted HR 2.13, 95%CI 1.16-3.71, P = 0.0152) and larger LA volume (adjusted HR 1.03, 95%CI 1.01-1.04, P = 0.0054) were independent predictors of AF recurrence after ablation.Assessment of the SNRT after defibrillation may help to predict a successful ablation in patients with longstanding persistent AF.(Int Heart J Advance Publication)

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

et al. 2018

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“…5 Persistent left SVC is also a well-recognised trigger site for AF. 19,21,[78][79][80][81][82][83][84][85] The connecting musculature means that multiple electrical signals are conducted to the posterolateral LA and middle portion of the CS from the left SVC trigger site. Complete left SVC isolation may be challenging, as it is close to the oesophagus and left phrenic nerve.…”

Section: Vena Cava Triggersmentioning

confidence: 99%

“…4-31 Non-PV ablation after multiple AF ablation procedures decreases the risk of recurrence and increases the cure rate. 10,[19][20][21]23,25,28,29 Although several ablation strategies have been developed, the outcomes of ablation are not improved unless substrate modification targets AF triggers. 30 Taking all of these considerations into account, non-PV ectopy plays important role in both AF initiation and recurrence.…”

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confidence: 99%

Catheter Ablation of Paroxysmal Atrial Fibrillation Originating from Non-pulmonary Vein Areas

Higa

Chen

2018

Arrhythmia &Amp; Electrophysiology Review

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Access at: www.AERjournal.com Catheter ablation of AF has become an established therapy and may have the potential to cure this most commonly encountered sustained arrhythmia. Previous studies have demonstrated that pulmonary veins (PVs) are a major source of the ectopic beats that initiate AF. PV isolation in patients with symptomatic paroxysmal AF refractory to antiarrhythmic drugs is effective; however, it is difficult to eliminate all instances of AF. 1-3 If ectopic foci consistently come from a non-PV area and a pattern of spontaneous onset of AF is onset confirmed, the earliest ectopic site is defined as the non-PV trigger initiating AF. 2,4-7 Ectopy originating from non-PV areas can initiate AF and can cause it to recur after PV isolation. 4-31 Non-PV ablation after multiple AF ablation procedures decreases the risk of recurrence and increases the cure rate. 10,[19][20][21]23,25,28,29 Although several ablation strategies have been developed, the outcomes of ablation are not improved unless substrate modification targets AF triggers. 30 Taking all of these considerations into account, non-PV ectopy plays important role in both AF initiation and recurrence. 2,[4][5][6][7]20,29,30,[32][33][34] Mapping studies of non-PV foci have revealed that triggers are often found in anatomically predictable regions, such as the left atrial wall, thoracic veins and crista terminalis, and can be sustained or non-sustained triggers of AF. These areas can be mapped by specific multielectrode catheters positioned in key regions and ablated after the AF is induced and localised, or they can be ablated empirically without the induction of ectopy. 1-34 This review focuses on catheter ablation of AF initiated by non-PV triggers, summarising the electrophysiological characteristics, mapping and ablation strategies, their safety and efficacy. Several important concepts have been proposed regarding the role of non-PV ectopy in initiating AF. 2,4-7 AF is initiated by non-PV disturbance of the cardiac rhythm in up to 39 % of cases. 3,8-10,32-38 The left atrium (LA) (25.3 %), superior vena cava (SVC) (22.2 %), coronary sinus (CS) (18.0 %), right atrium (RA) including the crista terminalis (17.4 %),interatrial septum (7.9 %), and ligament of Marshall (LOM) (3.9 %) are the areas in which non-PV triggers of de novo AF are most commonly found ( Table 1), whereas the SVC, interatrial septum and LA are the most common non-PV trigger sites in recurrent AF ( Table 2). Furthermore, there is a higher incidence of non-PV triggers initiating AF in females and in patients with an enlarged LA. 39 PathophysiologyHistological analysis of the embryonic sinus venosus has identified areas capable of spontaneous depolarisation at the junctions between different embryonic tissues, such as the RA-SVC junction, crista terminalis and CS ostium. [40][41][42] The SVC is a major origin of non-PV triggers of AF. 5,8,[32][33][34][43][44][45][46][47] Heterogeneity of the SVC sleeve and arrhythmogenicity of cardiomyocytes isolated from the SVC have been reported. 41...

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Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome

Kataoka

Ejima

Yazaki

et al. 2022

Journal of Arrhythmia

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Background Reports of long‐term outcomes after atrial fibrillation (AF) ablation for tachycardia‐bradycardia syndrome (TBS) are limited. This study aimed to investigate the impact of radiofrequency catheter ablation (RFCA) on clinical outcomes in patients with TBS. Methods Among 1669 patients who underwent AF ablation between January 2010 and April 2020, we retrospectively enrolled 53 patients (62.3% males; age, 67.1 ± 7.0 years) who had been diagnosed with TBS before RFCA for paroxysmal AF (TBS group). After 1:2 propensity score‐matching based on age, gender, AF type, and left atrial dimension, 106 patients were assigned to the control group (non‐TBS group). The atrial tachyarrhythmia (ATA) recurrence rate and rate of avoidance of permanent pacemaker implantation (PMI) were examined. Results During a median follow‐up period of 37.7 months, the ATA recurrence rate after a single ablation procedure was significantly higher in the TBS group than in the non‐TBS group (51.0% vs. 38.5%; log‐rank p = .008); however, the ATA recurrence rate after the final ablation procedure did not significantly differ between groups. In the TBS group, the rate of PMI avoidance after AF ablation was 92.5%. A Cox‐regression multivariate analysis revealed that the presence of non‐pulmonary vein/superior vena cava premature atrial contractions (odds ratio, 3.38; 95% confidence interval, 1.49–7.66; p = .004) was an independent predictor of ATA recurrence in the TBS group. Conclusions Patients with TBS had higher ATA recurrence rates after the first ablation procedure compared to those without TBS. However, ATA recurrence after AF ablation did not necessarily result in PMI for TBS patients.

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Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Cited by 21 publications

References 29 publications

Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

Catheter Ablation of Paroxysmal Atrial Fibrillation Originating from Non-pulmonary Vein Areas

Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome

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Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome – Important Role of Non-Pulmonary Vein Foci –

Cited by 21 publications

References 29 publications

Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

Catheter Ablation of Paroxysmal Atrial Fibrillation Originating from Non-pulmonary Vein Areas

Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome

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Resources

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Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –