Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.

<h4>Background</h4>Although long sinus arrest is occasionally observed during atrial fibrillation (AF) catheter ablation when the fibrillation was terminated, its meaning and prognosis have not yet been clearly elucidated. We hypothesized that sinus node recovery time (SNRT) after termin...

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Autores principales:	Keita Watanabe, Yasutoshi Nagata, Giichi Nitta, Shinichiro Okata, Masashi Nagase, Ryoichi Miyazaki, Sho Nagamine, Masakazu Kaneko, Tetsumin Lee, Toshihiro Nozato, Takashi Ashikaga, Masahiko Goya, Tetsuo Sasano
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/79ce0333b3cf4a2ca42e70433aaf883c
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spelling	oai:doaj.org-article:79ce0333b3cf4a2ca42e70433aaf883c2021-12-02T20:06:01ZImpact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.1932-620310.1371/journal.pone.0259750https://doaj.org/article/79ce0333b3cf4a2ca42e70433aaf883c2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0259750https://doaj.org/toc/1932-6203<h4>Background</h4>Although long sinus arrest is occasionally observed during atrial fibrillation (AF) catheter ablation when the fibrillation was terminated, its meaning and prognosis have not yet been clearly elucidated. We hypothesized that sinus node recovery time (SNRT) after termination of AF (time from termination of AF to the earliest sinus node activation) could reflect the extent of atrial remodeling, influencing the formation of non-pulmonary vein (non-PV) triggers and post-ablation outcomes.<h4>Method</h4>The participants were 157 consecutive patients with persistent AF (male: 77.1%, age: 63.3±11.2 years) who underwent catheter ablation. We recorded SNRT after terminating AF by radiofrequency delivery or electrical cardioversion during the first ablation and evaluated the relationships between SNRT and atrial tachyarrhythmia recurrence and between SNRT and non-PV triggers after repeat ablation.<h4>Results</h4>Forty-five patients (28.7%) experienced recurrence of atrial tachyarrhythmias. Patients with recurrence had longer SNRTs (1738 ms vs. 1394 ms, p = 0.012). In the multivariate logistic regression analysis, only SNRT ≥2128ms was a significant independent predictor of clinical AF recurrence (hazard ratio 7.48; 95% confidence interval 2.94-19.00; P<0.001). Kaplan-Meier estimator showed that the recurrence-free rate was significantly lower if ≥ 2128ms (log-rank, p<0.001). Thirty-five patients (77.8%) underwent a second ablation. Although there was no difference in the rate of pulmonary vein reconnections (78.6% vs. 71.4%, p = 0.712), non-PV triggers were observed more frequently in the longer SNRT group (57.1% vs. 14.3%, p = 0.012).<h4>Conclusions</h4>Patients with a prolonged SNRT had a higher prevalence of AF recurrence after the first ablation and higher inducibility of non-PV triggers. Measuring SNRT might be used for the stratification of patients with persistent AF.Keita WatanabeYasutoshi NagataGiichi NittaShinichiro OkataMasashi NagaseRyoichi MiyazakiSho NagamineMasakazu KanekoTetsumin LeeToshihiro NozatoTakashi AshikagaMasahiko GoyaTetsuo SasanoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0259750 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Keita Watanabe Yasutoshi Nagata Giichi Nitta Shinichiro Okata Masashi Nagase Ryoichi Miyazaki Sho Nagamine Masakazu Kaneko Tetsumin Lee Toshihiro Nozato Takashi Ashikaga Masahiko Goya Tetsuo Sasano Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.
description	<h4>Background</h4>Although long sinus arrest is occasionally observed during atrial fibrillation (AF) catheter ablation when the fibrillation was terminated, its meaning and prognosis have not yet been clearly elucidated. We hypothesized that sinus node recovery time (SNRT) after termination of AF (time from termination of AF to the earliest sinus node activation) could reflect the extent of atrial remodeling, influencing the formation of non-pulmonary vein (non-PV) triggers and post-ablation outcomes.<h4>Method</h4>The participants were 157 consecutive patients with persistent AF (male: 77.1%, age: 63.3±11.2 years) who underwent catheter ablation. We recorded SNRT after terminating AF by radiofrequency delivery or electrical cardioversion during the first ablation and evaluated the relationships between SNRT and atrial tachyarrhythmia recurrence and between SNRT and non-PV triggers after repeat ablation.<h4>Results</h4>Forty-five patients (28.7%) experienced recurrence of atrial tachyarrhythmias. Patients with recurrence had longer SNRTs (1738 ms vs. 1394 ms, p = 0.012). In the multivariate logistic regression analysis, only SNRT ≥2128ms was a significant independent predictor of clinical AF recurrence (hazard ratio 7.48; 95% confidence interval 2.94-19.00; P<0.001). Kaplan-Meier estimator showed that the recurrence-free rate was significantly lower if ≥ 2128ms (log-rank, p<0.001). Thirty-five patients (77.8%) underwent a second ablation. Although there was no difference in the rate of pulmonary vein reconnections (78.6% vs. 71.4%, p = 0.712), non-PV triggers were observed more frequently in the longer SNRT group (57.1% vs. 14.3%, p = 0.012).<h4>Conclusions</h4>Patients with a prolonged SNRT had a higher prevalence of AF recurrence after the first ablation and higher inducibility of non-PV triggers. Measuring SNRT might be used for the stratification of patients with persistent AF.
format	article
author	Keita Watanabe Yasutoshi Nagata Giichi Nitta Shinichiro Okata Masashi Nagase Ryoichi Miyazaki Sho Nagamine Masakazu Kaneko Tetsumin Lee Toshihiro Nozato Takashi Ashikaga Masahiko Goya Tetsuo Sasano
author_facet	Keita Watanabe Yasutoshi Nagata Giichi Nitta Shinichiro Okata Masashi Nagase Ryoichi Miyazaki Sho Nagamine Masakazu Kaneko Tetsumin Lee Toshihiro Nozato Takashi Ashikaga Masahiko Goya Tetsuo Sasano
author_sort	Keita Watanabe
title	Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.
title_short	Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.
title_full	Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.
title_fullStr	Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.
title_full_unstemmed	Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.
title_sort	impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/79ce0333b3cf4a2ca42e70433aaf883c
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Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation.

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