Subclinical sinus node dysfunction in patients with atrial fibrillation—Insight from ultrahigh‐resolution mapping of human sinoatrial exits. (20th September 2022)

• Record Type: Journal Article
• Authors: Eguchi, Tomoya; Miyazaki, Shinsuke; Tsuji, Toshihiko; Nagao, Moeko; Kakehashi, Shota; Mukai, Moe; Sekihara, Takayuki; Aoyama, Daisetsu; Nodera, Minoru; Hasegawa, Kanae; Uzui, Hiroyasu; Tada, Hiroshi
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 33:Number 12(2022)
• Page Start: 2599
• Page End: 2605
• Publication Date: 2022-09-20
• Subjects: atrial fibrillation -- earliest atrial activation -- sinus node dysfunction; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15673
• Languages: English
• ISSNs: 1045-3873

Abstract

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 β‐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 β‐stimulation (SVT/PAF/PsAF = 2.6 ± 1.0/1.3 ± 0.6/1.0 ± 0, p < .01). The number significantly increased with β‐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 β‐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 β‐stimulation than non‐AF patients. An elevated BNP level might predict subclinical SN dysfunction in patients with PAF.