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Prediction of sinus node dysfunction in patients with persistent atrial flutter using the flutter cycle length.

Akinori Sairaku¹, Yukiko Nakano, Noboru Oda

¹Department of Cardiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 7348551, Japan. rjrgw059@ybb.ne.jp

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

|September 20, 2011

Summary

Identifying sinus node dysfunction (SND) in patients with atrial flutter (AFL) is challenging. A longer flutter cycle length (FCL) can predict the need for a pacemaker in patients with AFL and underlying SND.

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Area of Science:

Cardiology
Electrophysiology
Internal Medicine

Background:

Sinus node dysfunction (SND) can coexist with atrial flutter (AFL).
Diagnosing SND during AFL is clinically difficult.
Flutter cycle length (FCL) may offer predictive insights.

Purpose of the Study:

To investigate if FCL can predict underlying SND in patients with persistent AFL.
To determine the optimal FCL cutoff for predicting SND requiring pacemaker implantation.

Main Methods:

Retrospective analysis of 211 patients with cavotricuspid isthmus (CTI)-dependent AFL.
Measurement of FCL before ablation and corrected sinus node recovery time (CSNRT) post-ablation.
Receiver-operating characteristic (ROC) curve analysis to identify predictive FCL values.

Main Results:

11% of patients required pacemaker implantation for SND.
Patients needing pacemakers had significantly longer FCL (295±37 ms vs. 236±34 ms) and higher CSNRT (1727±1014 ms vs. 603±733 ms).
An FCL >273 ms was optimal for predicting SND requiring pacemaker implantation (AUC 0.91, sensitivity 83%, specificity 89%).
Independent predictors for SND requiring pacemaker included female sex, LVEF <50%, and FCL >273 ms.

Conclusions:

Assessing FCL in patients with persistent CTI-dependent AFL can aid in risk stratification for underlying SND.
FCL is a valuable non-invasive marker for predicting the need for pacemaker implantation in this patient group.