Up to 6-year follow-up after pulmonary vein isolation for persistent/permanent atrial fibrillation: importance of sinus node function.
OBJECTIVE
Sinus node dysfunction is commonly associated with atrial fibrillation. There is little information about the long-term results of pulmonary vein isolation in relation to sinus node function. The present study was conducted to investigate whether sinus node dysfunction affects the late outcome of pulmonary vein isolation in patients with persistent/permanent atrial fibrillation.


METHODS
Among 76 consecutive patients with persistent/permanent atrial fibrillation who had undergone cut-and-sew pulmonary vein isolation, 66 patients without evidence of intra-atrial thrombus by transesophageal echography, and who were able to tolerate cardioversion, were enrolled. Sinus node recovery time after cardioversion was examined intraoperatively. All of the patients underwent valvular surgery concomitantly (mitral in 62).


RESULTS
Sinus node dysfunction was detected in 18 patients. These patients had a significantly lower f wave voltage in V(1) of the electrocardiogram and a larger cardiothoracic ratio than patients with normal sinus node function. Hospital mortality was 3%, and 3 late deaths were observed. Follow-up was conducted for up to 72 months (mean 30 months), with a 100% complete follow-up rate. There were no significant differences in actuarial survival and freedom from cardiac events between patients with normal and abnormal sinus node function. No thromboembolic events occurred. A significantly higher proportion of patients with normal sinus node function (82%) were free of atrial fibrillation at 4 years than patients with sinus node dysfunction (25%; P < .0001).


CONCLUSIONS
The atrial fibrillation cure rate after pulmonary vein isolation may be influenced by sinus node function in both the early and late stages. Although further examinations are required, pulmonary vein isolation may be an adequate treatment for persistent/permanent atrial fibrillation in patients with normal sinus node function.
Soga
Yoshiharu
Y
Department of Cardiovascular Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara, Japan. sogakin@dd.iij4u.or.jp
Okabayashi
Hitoshi
H
Arai
Yoshio
Y
Nomoto
Takuya
T
Nakano
Jota
J
Matsuo
Takehiko
T
Hanyu
Michiya
M
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006351:Heart Valves / Q000503:physiopathology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012804:Sick Sinus Syndrome / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome