Subclinical sinus node dysfunction in patients with atrial fibrillation-Insight from ultrahigh-resolution mapping of human sinoatrial exits.
J Cardiovasc Electrophysiol
; 33(12): 2599-2605, 2022 12.
Article
em En
| MEDLINE
| ID: mdl-36104930
ABSTRACT
BACKGROUND:
Even a short duration of paroxysmal episodes of atrial fibrillation (AF) is associated with sinus node (SN) remodeling and a reduced SN reserve or dysfunction. The number of earliest atrial activation sites (EASs) during sinus rhythm decreases according to the decrease in the SN reserve.OBJECTIVE:
We sought to evaluate the EASs during sinus rhythm using an ultrahigh-density mapping system.METHODS:
This study included 35 patients (supraventricular tachycardia [SVT]/paroxysmal atrial fibrillation [PAF]/persistent atrial fibrillation [PsAF] = 5/21/9) who underwent ultrahigh-resolution endocardial mapping of the SN area at rest and during ß-stimulation. The number of EASs was determined by the Lumipoint™ algorithm.RESULTS:
The number of EASs was greatest in SVT patients both at rest (SVT/PAF/PsAF = 1.4 ± 0.8/1.0 ± 0/1.0 ± 0, p = .04) and during ß-stimulation (SVT/PAF/PsAF = 2.6 ± 1.0/1.3 ± 0.6/1.0 ± 0, p < .01). The number significantly increased with ß-stimulation as compared to baseline in the PAF patients (p = .02), but not in the PsAF patients. The brain natriuretic peptide (BNP) level was significantly higher in AF than SVT patients (SVT/PAF/PsAF = 12.3 [10.1-14.5]/25.7 [14.8-36.0]/73.4 [57.6-140] pg/ml, p < .01). In the PAF patients, the BNP level was significantly higher in those with unicentric EASs than multicentric EASs during ß-stimulation (28.1 [19.1-46.5] vs. 13.1 [9.4-26.9] pg/ml, p = .03), and the optimal cutoff point for the BNP level predicting unicentric EASs was 21.8 pg/ml (sensitivity 82.6%; specificity 85.7%).CONCLUSIONS:
AF patients have a smaller number of EASs and poorer response to ß-stimulation than non-AF patients. An elevated BNP level might predict subclinical SN dysfunction in patients with PAF.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Taquicardia Paroxística
/
Taquicardia Supraventricular
Tipo de estudo:
Clinical_trials
Limite:
Humans
Idioma:
En
Revista:
J Cardiovasc Electrophysiol
Ano de publicação:
2022
Tipo de documento:
Article