title: A low fibrillatory wave amplitude predicts sinus node dysfunction after catheter ablation in patients with persistent atrial fibrillation.
abstract: BACKGROUND
  Concealed sinus node dysfunction (SND) may become manifest after restoration of sinus rhythm by ablation in patients with persistent atrial fibrillation (AF). The purpose of this study was to investigate the predictors of SND after catheter ablation of persistent AF.
  
  
  METHODS
  Two hundred two consecutive patients who underwent ablation for persistent AF were enrolled. Ipsilateral pulmonary vein isolation followed by, if necessary, electrical cardioversion were performed in all patients. SND was defined when temporary and/or permanent pacemakers were needed due to sinus bradycardia after ablation.
  
  
  RESULTS
  SND developed in 12 (5.9 %) patients. There was no difference between the patients with and without SND in terms of the age (with SND, 67 ± 9 and without, 66 ± 10 years old, P = 0.599) and sex (male; 58 vs. 79 %, P = 0.186). However, the patients with SND had a lower amplitude of the fibrillatory waves (0.115 ± 0.086 vs. 0.176 ± 0.077 mV, P = 0.009) and larger left atrial volume index (LAVI; 66 ± 31 vs. 34 ± 13, P = 0.007) than those without. A receiver operating characteristic curve identified a fibrillatory wave amplitude of 0.145 mV (AUC = 0.742; sensitivity = 65 %; specificity = 83 %) and LAVI of 47.5 ml/m(2) (AUC = 0.837; sensitivity = 82 %; specificity = 87 %) as the optimal cutoff values for predicting SND. A multivariate analysis revealed that the amplitude of the fibrillatory waves (odds ratio = 0.84 for 0.010 mV increase, 95 % CI = 0.71-0.98, P = 0.031) and LAVI (odds ratio = 1.08 for 1.0 cm(3)/m(2) increase, 95 % CI = 1.04-1.12, P < 0.001) were independent risk factors for SND.
  
  
  CONCLUSIONS
  A low amplitude of the fibrillatory waves and a large LAVI were predictors of SND after restoration of sinus rhythm by ablation in patients with persistent AF.
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, 3-1-69, Inabaso, Amagasakishi, Hyogo, 660-8511, Japan, a.sunaga519@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sunaga
authors.forename: Masaharu
authors.initials: M
authors.lastname: Masuda
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanda
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujita
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.forename: Shin
authors.initials: S
authors.lastname: Okamoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ishihara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uematsu
mesh_terms: D000368:Aged; D001146:Arrhythmia, Sinus / Q000175:diagnosis* / Q000209:etiology*; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis*; D017115:Catheter Ablation / Q000009:adverse effects*; D002908:Chronic Disease; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity