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Post-shock sinus node recovery time is an independent predictor of recurrence after catheter ablation of longstanding persistent atrial fibrillation

 Junbeom Park  ;  Jaemin Shim  ;  Jae-Sun Uhm  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Hui-Nam Pak 
 INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol.168(3) : 1937-1942, 2013 
Journal Title
Issue Date
Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology* ; Atrial Fibrillation/surgery ; Catheter Ablation/methods* ; Electric Countershock/methods* ; Electrophysiologic Techniques, Cardiac* ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Period ; Recovery of Function/physiology* ; Recurrence ; Sinoatrial Node/physiology* ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome
Atrial fibrillation ; Catheter ablation ; Left atrium remodeling ; Post-shock sinus recovery time
BACKGROUND: Electro-anatomical remodeling of the atria has been reported to be associated with sinus node dysfunction in patients with atrial fibrillation (AF). We hypothesized that post-shock sinus node recovery time (PS-SNRT: the time from cardioversion to the earliest sinus node activation) is related to the degree of left atrial (LA) remodeling and the clinical outcome of radiofrequency catheter ablation (RFCA) in patients with longstanding persistent AF (L-PeAF). METHODS AND RESULTS: We included 117 patients with L-PeAF (82.0% males, 55.4 ± 10.7 years old) who underwent RFCA. PS-SNRTs were measured after internal cardioversion (serial shocks 2, 3, 5, 7, 10, and 15J) before RFCA. All patients underwent the same ablation design, and we compared regional LA volume (3D-CT imaging) and LA voltage (NavX). RESULTS: 1. During the 13.5 ± 5.8-month follow-up period, it was noted that the patients with recurrent AF 3 months after RFCA (n=31) had longer PS-SNRTs (1622.90 ± 1196.92 ms vs. 1112.53 ± 690.68 ms, p=0.005) and greater anterior LA volume (p=0.032) than those who remained in sinus rhythm. 2. The patients with PS-SNRT ≥ 1100 ms showed lower AF-free rates (58.3%) compared to those with PS-SNRT <1100 ms (89.5%, p<0.001). However, shock energy, number of cardioversion, and LA volume were not different between two groups. 3. Multivariate Cox regression analysis demonstrated PS-SNRT ≥ 1100 ms was a significant predictor of clinical recurrence of AF (HR 5.426, 95% CI 2.099-14.028, p<0.001). CONCLUSION: In patients with L-PeAF, prolonged PS-SNRT is an independent predictor of clinical recurrence of AF after RFCA, but not closely associated with electro-anatomical remodeling of LA.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Beom(박준범)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Jae Min(심재민)
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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