title: Prediction of sinus node dysfunction in patients with long-standing persistent atrial fibrillation using the atrial fibrillatory cycle length.
abstract: BACKGROUND
  Sinus node dysfunction (SND) occasionally coexists with long-standing atrial fibrillation (AF) but is unidentifiable during AF. We aimed to identify the predictors of underlying SND when deciding the indications for long-standing persistent AF ablation.
  
  
  METHODS
  We included 105 patients undergoing ablation of long-standing persistent AF to assess the frequency of a permanent pacemaker implantation (PMI) for SND that manifested after sinus conversion and to determine the relationship between the corrected sinus node recovery time (CSNRT) and other clinical parameters obtained before the ablation including the atrial fibrillatory cycle length (AFCL).
  
  
  RESULTS
  We identified 7 patients (7%) requiring a PMI for SND after AF termination. The patients with a PMI were nearly all females (6/7) and had a significantly longer CSNRT (1197 ± 647 vs 612 ± 349 milliseconds; P = .0046) and more prolonged AFCL (179 ± 19 vs 153 ± 22 milliseconds; P = .0028) than those without. The age (r = 0.26; P = .011), female sex (r = 0.25; P = .012), hypertension (r = 0.22; P = .038), and AFCL (r = 0.4; P < .0001) were significantly correlated with the CSNRT. A stepwise multivariate linear regression analysis including these parameters revealed that the AFCL was the only independent determinant of the CSNRT (β = 0.38; P = .0012). A receiver operating characteristic curve identified an AFCL of more than 162 milliseconds as the optimal cutoff value for predicting SND requiring a PMI (area under the curve, 0.84; sensitivity, 86%; specificity, 74%; P = .0066).
  
  
  CONCLUSIONS
  A prolonged AFCL was significantly associated with SND. Thus, assessing the AFCL in the patients with long-standing persistent AF may be helpful for the risk stratification of underlying SND.
authors.affiliation: Department of Cardiology, Hiroshima University, Hiroshima, Japan. rjrgw059@ybb.ne.jp
authors.forename: Akinori
authors.initials: A
authors.lastname: Sairaku
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakano
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.forename: Yuko
authors.initials: Y
authors.lastname: Makita
authors.forename: Kenta
authors.initials: K
authors.lastname: Kajihara
authors.forename: Takehito
authors.initials: T
authors.lastname: Tokuyama
authors.forename: Chikaaki
authors.initials: C
authors.lastname: Motoda
authors.forename: Mai
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012804:Sick Sinus Syndrome / Q000503:physiopathology* / Q000628:therapy*