Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery: Determinants and clinical outcomes

Darae Kim, Chi Young Shim, Geu Ru Hong, In Jeong Cho, Seung Hyun Lee, Hyuk Jae Chang, Sak Lee, Jong Won Ha, Byung Chul Chang

Research output: Contribution to journalArticle

Abstract

Objective We sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied. Study design and setting SND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after surgery. Baseline clinical and echocardiographic characteristics, rhythm outcomes [AF recurrence or permanent pacemaker (PM) implantation] at 6 and 12 months, and clinical outcomes were compared between patients without SND (n = 165) and those with SND (n = 37) after surgery. Results Patients with SND showed a significantly larger left atrial volume index (LAVI) and a higher right ventricular systolic pressure than those without SND. In addition, there was a higher likelihood for AF recurrence and PM implantation in patients with SND than in those without SND. Although clinical outcomes did not differ between the two groups, patients with SND had a significantly longer length of hospital stay (p<0.001). In a multivariate analysis, preoperative LAVI was a structural risk factor for SND [hazard ratio (HR): 1.126 per 10 mL/m 2 ; 95% confidence interval (CI): 1.0206–1.236; p = 0.001]. An LAVI cut-off value of 105 mL/m 2 showed significant predictive power for SND [sensitivity: 62%; specificity: 64%; area under the curve (AUC): 0.678; p = 0.002]. Conclusions In conclusion, preoperative LA size was a structural risk factor for SND after surgical AF ablation during MV surgery. SND was associated with an increased risk for AF recurrence and implantation of permanent PM in patients undergoing concomitant surgical ablation of AF with MV surgery.

Original languageEnglish
Article numbere0203828
JournalPloS one
Volume13
Issue number9
DOIs
Publication statusPublished - 2018 Sep

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Sick Sinus Syndrome
Ablation
sinuses
Mitral Valve
Atrial Fibrillation
Surgery
surgery
Pacemakers
Bradycardia
atrial fibrillation
Hazards
Recurrence
Length of Stay
risk factors
Ventricular Pressure
Ambulatory Surgical Procedures

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Kim, Darae ; Shim, Chi Young ; Hong, Geu Ru ; Cho, In Jeong ; Lee, Seung Hyun ; Chang, Hyuk Jae ; Lee, Sak ; Ha, Jong Won ; Chang, Byung Chul. / Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery : Determinants and clinical outcomes. In: PloS one. 2018 ; Vol. 13, No. 9.
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abstract = "Objective We sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied. Study design and setting SND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after surgery. Baseline clinical and echocardiographic characteristics, rhythm outcomes [AF recurrence or permanent pacemaker (PM) implantation] at 6 and 12 months, and clinical outcomes were compared between patients without SND (n = 165) and those with SND (n = 37) after surgery. Results Patients with SND showed a significantly larger left atrial volume index (LAVI) and a higher right ventricular systolic pressure than those without SND. In addition, there was a higher likelihood for AF recurrence and PM implantation in patients with SND than in those without SND. Although clinical outcomes did not differ between the two groups, patients with SND had a significantly longer length of hospital stay (p<0.001). In a multivariate analysis, preoperative LAVI was a structural risk factor for SND [hazard ratio (HR): 1.126 per 10 mL/m 2 ; 95{\%} confidence interval (CI): 1.0206–1.236; p = 0.001]. An LAVI cut-off value of 105 mL/m 2 showed significant predictive power for SND [sensitivity: 62{\%}; specificity: 64{\%}; area under the curve (AUC): 0.678; p = 0.002]. Conclusions In conclusion, preoperative LA size was a structural risk factor for SND after surgical AF ablation during MV surgery. SND was associated with an increased risk for AF recurrence and implantation of permanent PM in patients undergoing concomitant surgical ablation of AF with MV surgery.",
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Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery : Determinants and clinical outcomes. / Kim, Darae; Shim, Chi Young; Hong, Geu Ru; Cho, In Jeong; Lee, Seung Hyun; Chang, Hyuk Jae; Lee, Sak; Ha, Jong Won; Chang, Byung Chul.

In: PloS one, Vol. 13, No. 9, e0203828, 09.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery

T2 - Determinants and clinical outcomes

AU - Kim, Darae

AU - Shim, Chi Young

AU - Hong, Geu Ru

AU - Cho, In Jeong

AU - Lee, Seung Hyun

AU - Chang, Hyuk Jae

AU - Lee, Sak

AU - Ha, Jong Won

AU - Chang, Byung Chul

PY - 2018/9

Y1 - 2018/9

N2 - Objective We sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied. Study design and setting SND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after surgery. Baseline clinical and echocardiographic characteristics, rhythm outcomes [AF recurrence or permanent pacemaker (PM) implantation] at 6 and 12 months, and clinical outcomes were compared between patients without SND (n = 165) and those with SND (n = 37) after surgery. Results Patients with SND showed a significantly larger left atrial volume index (LAVI) and a higher right ventricular systolic pressure than those without SND. In addition, there was a higher likelihood for AF recurrence and PM implantation in patients with SND than in those without SND. Although clinical outcomes did not differ between the two groups, patients with SND had a significantly longer length of hospital stay (p<0.001). In a multivariate analysis, preoperative LAVI was a structural risk factor for SND [hazard ratio (HR): 1.126 per 10 mL/m 2 ; 95% confidence interval (CI): 1.0206–1.236; p = 0.001]. An LAVI cut-off value of 105 mL/m 2 showed significant predictive power for SND [sensitivity: 62%; specificity: 64%; area under the curve (AUC): 0.678; p = 0.002]. Conclusions In conclusion, preoperative LA size was a structural risk factor for SND after surgical AF ablation during MV surgery. SND was associated with an increased risk for AF recurrence and implantation of permanent PM in patients undergoing concomitant surgical ablation of AF with MV surgery.

AB - Objective We sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied. Study design and setting SND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after surgery. Baseline clinical and echocardiographic characteristics, rhythm outcomes [AF recurrence or permanent pacemaker (PM) implantation] at 6 and 12 months, and clinical outcomes were compared between patients without SND (n = 165) and those with SND (n = 37) after surgery. Results Patients with SND showed a significantly larger left atrial volume index (LAVI) and a higher right ventricular systolic pressure than those without SND. In addition, there was a higher likelihood for AF recurrence and PM implantation in patients with SND than in those without SND. Although clinical outcomes did not differ between the two groups, patients with SND had a significantly longer length of hospital stay (p<0.001). In a multivariate analysis, preoperative LAVI was a structural risk factor for SND [hazard ratio (HR): 1.126 per 10 mL/m 2 ; 95% confidence interval (CI): 1.0206–1.236; p = 0.001]. An LAVI cut-off value of 105 mL/m 2 showed significant predictive power for SND [sensitivity: 62%; specificity: 64%; area under the curve (AUC): 0.678; p = 0.002]. Conclusions In conclusion, preoperative LA size was a structural risk factor for SND after surgical AF ablation during MV surgery. SND was associated with an increased risk for AF recurrence and implantation of permanent PM in patients undergoing concomitant surgical ablation of AF with MV surgery.

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