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Type: Journal article
Title: Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses
Author: Hocini, M.
Sanders, P.
Deisenhofer, I.
Jais, P.
Hsu, L.
Scavee, C.
Weerasooriya, R.
Raybaud, F.
MacLe, L.
Shah, D.
Garrigue, S.
Le Metayer, P.
Clementy, J.
Haissaguerre, M.
Citation: Circulation, 2003; 108(10):1172-1175
Publisher: Lippincott Williams & Wilkins
Issue Date: 2003
ISSN: 0009-7322
Statement of
Mélèze Hocini, Prashanthan Sanders, Isabel Deisenhofer, Pierre Jaïs, Li-Fern Hsu, Christophe Scavée, Rukshen Weerasoriya, Florence Raybaud, Laurent Macle, Dipen C. Shah, Stéphane Garrigue, Philippe Le Metayer, Jacques Clémenty, and Michel Haïssaguerre
Abstract: <h4>Background</h4>Symptomatic prolonged sinus pauses on termination of atrial fibrillation (AF) are an indication for pacemaker implantation. We evaluated sinus node function and clinical outcome in patients with prolonged sinus pauses on termination of arrhythmia who underwent ablation of paroxysmal AF.<h4>Methods and results</h4>Twenty patients with paroxysmal AF and prolonged sinus pauses (> or =3 seconds) on termination of AF underwent ablation between May 1995 and November 2002. Patients with sinus pauses independent of episodes of AF were excluded from the analysis. The procedure included pulmonary vein and linear atrial ablation. After ablation, sinus node function was assessed during the first week and at 1, 3, and 6 months, by 24-hour ambulatory monitoring to determine the mean heart rate and heart rate range, and by exercise testing to determine the maximal heart rate. Corrected sinus node recovery time was determined at the completion of ablation and at 24.0+/-11.3 months at 600 and 400 ms. After AF ablation, there was a significant improvement of sinus node function, with an increase in the mean heart rate (P=0.001), maximal heart rate (P<0.0001), and heart rate range (P<0.0001). The corrected sinus node recovery time decreased in all patients evaluated at 600 ms (P=0.016) and 400 ms (P=0.019). At 26.0+/-17.6 months, 18 patients (85%) had no recurrence of AF (in the absence of medication), with no symptoms attributable to bradycardia or sinus pauses on ambulatory monitoring. Two patients had infrequent episodes of AF, 1 requiring pacemaker implantation.<h4>Conclusions</h4>Prolonged sinus pauses after paroxysms of AF may result from depression of sinus node function that can be eliminated by curative ablation of AF. This is accompanied by improvement in parameters of sinus node function, suggesting reverse remodeling of the sinus node.
Keywords: Sinoatrial Node
Atrial Fibrillation
Electrophysiologic Techniques, Cardiac
Exercise Test
Catheter Ablation
Treatment Outcome
Follow-Up Studies
Heart Rate
Middle Aged
Description: © 2003 Lippincott Williams & Wilkins
DOI: 10.1161/01.CIR.0000090685.13169.07
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