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Abnormal response of superior sinoatrial node to sympathetic stimulation is a characteristic finding in patients with atrial fibrillation and symptomatic bradycardia

Authors
 Boyoung Joung  ;  Hye Jin Hwang  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Changyu Shen  ;  Shien-Fong Lin  ;  Peng-Sheng Chen 
Citation
 CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol.4(6) : 799-807, 2011 
Journal Title
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY
ISSN
 1941-3149 
Issue Date
2011
MeSH
Adrenergic beta-Agonists ; Adult ; Aged ; Analysis of Variance ; Atrial Fibrillation/diagnosis* ; Atrial Fibrillation/physiopathology ; Bradycardia/diagnosis* ; Bradycardia/physiopathology ; Cardiac Pacing, Artificial* ; Case-Control Studies ; Electrocardiography ; Electrophysiologic Techniques, Cardiac* ; Female ; Humans ; Imaging, Three-Dimensional ; Isoproterenol ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Recovery of Function ; Republic of Korea ; Sinoatrial Node/innervation* ; Sinoatrial Node/physiopathology ; Sympathetic Nervous System/physiopathology* ; Time Factors
Keywords
pacemakers ; sick sinus syndrome ; atrial fibrillation ; nervous system sympathetic ; sinoatrial node
Abstract
BACKGROUND: We hypothesized that unresponsiveness of superior sinoatrial node (SAN) to sympathetic stimulation is strongly associated with the development of symptomatic bradycardia in patients with atrial fibrillation (AF).

METHODS AND RESULTS: We performed 3D endocardial mapping in healthy controls (group 1, n=10) and patients with AF without (group 2, n=57) or with (group 3, n=15) symptomatic bradycardia at baseline and during isoproterenol infusion. Corrected SAN recovery time was abnormal in 0%, 11%, and 36% of groups 1, 2, and 3, respectively (P=0.02). At baseline, 90%, 26%, and 7% (P<0.001) of the patients had multicentric SAN activation patterns. For groups 1, 2, and 3, the median distance from the superior vena cava-right atrial junction to the most cranial earliest activation site (EAS) was 5.0 (25-75 percentile range, 3.5-21.3), 10.0 (4-20), and 17.5 (12-34) mm at baseline (P=0.01), respectively, and 4.0 (0-5), 5.0 (1-10), and 15.0 (5.4-33.3) mm, respectively, during isoproterenol infusion (P=0.01), suggesting an upward shift of EAS during isoproterenol infusion. However, although the EAS during isoproterenol infusion was at the upper one third of the crista terminalis in 100% of group 1 and 78% of group 2 patients, only 20% of group 3 patients showed a move of the EAS to that region (P<0.001).

CONCLUSIONS: Superior SAN serves as the EAS during sympathetic stimulation in patients without AF and in most patients with AF without symptomatic bradycardia. In contrast, unresponsiveness of superior SAN to sympathetic stimulation is a characteristic finding in patients with AF and symptomatic bradycardia.
Files in This Item:
T201105012.pdf Download
DOI
10.1161/CIRCEP.111.965897
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
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
Hwang, Hye Jin(황혜진)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94891
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