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Prediction of sinus node dysfunction in patients with persistent atrial flutter using the flutter cycle length.
MedLine Citation:
PMID:  21926411     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AimsSinus node dysfunction (SND) occasionally coexists with atrial flutter (AFL). However, the identification of SND during AFL is difficult. We investigated whether we could predict underlying SND in patients with persistent AFL using the flutter cycle length (FCL).Methods and resultsWe retrospectively studied 211 successfully ablated patients with persistent cavotricuspid isthmus (CTI)-dependent AFL and measured the FCL before the ablation and corrected sinus node recovery time (CSNRT) after the ablation. Twenty-four patients (11%) required a permanent pacemaker implantation (PMI) for significant SND after AFL termination and had a longer FCL (295 ± 37 vs. 236 ± 34 ms; P < 0.0001) and greater CSNRT (1727 ± 1014 vs. 603 ± 733 ms; P < 0.0001) than those not requiring a PMI. A receiver-operating characteristic curve identified an FCL of >273 ms as the optimal cut-off value for predicting SND requiring a PMI (area under the curve 0.91; sensitivity, 83% and specificity, 89%; P < 0.0001). Multiple linear and logistic regression analyses revealed that the left ventricular ejection fraction (LVEF) (β = -0.2; P = 0.0016) and FCL (β = 0.46; P < 0.0001) were independently associated with the CSNRT, and that females [odds ratio (OR), 2.43; 95% confidence interval (CI), 1.32-4.62; P = 0.0046], an LVEF < 50% (OR, 2.10; 95% CI, 1.20-3.87; P = 0.012), and an FCL of >273 ms (OR, 5.34; 95% CI, 3.08-10.08; P < 0.0001) were independent predictors of SND requiring a PMI.ConclusionAlthough this study was based on a review of a database, the results suggest that assessing the FCL in patients with persistent CTI-dependent AFL could be helpful in the risk stratification of underlying SND.
Authors:
Akinori Sairaku; Yukiko Nakano; Noboru Oda; Yuko Makita; Kenta Kajihara; Takehito Tokuyama; Chikaaki Motoda; Mai Fujiwara; Yasuki Kihara
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-16
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Cardiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 7348551, Japan.
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