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Updated: May 25, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prediction of sinus node dysfunction in patients with long-standing persistent atrial fibrillation using the atrial
Akinori Sairaku1, Yukiko Nakano, Noboru Oda
1Department of Cardiology, Hiroshima University, Hiroshima, Japan. rjrgw059@ybb.ne.jp
Insights
Sinus node dysfunction (SND) is often hidden during atrial fibrillation (AF). A prolonged atrial fibrillation cycle length (AFCL) can predict underlying SND, aiding risk stratification before AF ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Sinus node dysfunction (SND) can coexist with long-standing persistent atrial fibrillation (AF), but it is difficult to diagnose during AF.
- Identifying predictors of SND is crucial for determining the appropriate indications for ablation in patients with long-standing persistent AF.
Purpose of the Study:
- To assess the frequency of permanent pacemaker implantation (PMI) for SND after sinus conversion in patients undergoing ablation for long-standing persistent AF.
- To identify predictors of SND, specifically the relationship between corrected sinus node recovery time (CSNRT) and pre-ablation clinical parameters like atrial fibrillatory cycle length (AFCL).
Main Methods:
- A cohort of 105 patients undergoing ablation for long-standing persistent AF was analyzed.
- The study assessed the incidence of PMI for SND post-ablation and correlated CSNRT with pre-ablation parameters, including AFCL.
- Statistical analyses included correlation, stepwise multivariate linear regression, and receiver operating characteristic (ROC) curve analysis.
Main Results:
- Seven percent of patients (7/105) required a PMI for SND after AF termination.
- Patients needing a PMI exhibited significantly longer CSNRT and AFCL compared to those who did not.
- A prolonged AFCL (>162 milliseconds) was identified as an optimal predictor of SND requiring PMI, with high sensitivity and specificity (AUC=0.84).
Conclusions:
- A prolonged AFCL is significantly associated with underlying sinus node dysfunction (SND) in patients with long-standing persistent AF.
- Measuring AFCL before ablation can aid in the risk stratification for identifying patients with occult SND.
- This finding supports pre-ablation assessment of AFCL to guide clinical decision-making regarding pacemaker implantation.
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.
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