Straight Back Syndrome and Non-Pulmonary Vein-Related Atrial Tachyarrhythmias in Atrial Fibrillation Catheter...

Straight Back Syndrome (SBS) is a congenital condition characterized by loss of normal thoracic kyphosis and chest narrowing, which can cause cardiac compression. Although linked to cardiovascular abnormalities, its relationship with atrial arrhythmia remains unclear. This study aimed to investigate the association between SBS and non-pulmonary vein (PV)-related atrial tachyarrhythmias (ATAs) in patients with atrial fibrillation (AF).

We retrospectively analyzed 222 consecutive patients (mean age, 65.8 ± 11.3 years) who underwent initial AF ablation. Following PV isolation, ATAs were induced and assessed using intracardiac electrocardiography. SBS was diagnosed by chest radiography and thoracic computed tomography. Twenty-seven patients were classified into the SBS group, and 195 into the control group.

Compared with controls, the SBS group had a lower body mass index, smaller left atrial diameter, and lower prevalence of hypertension and diabetes. Non-PV-related ATAs were more frequently induced in the SBS group (18/27 vs. 50/195, p < 0.01), including non-PV-triggered AF (7/27 vs. 16/195, p < 0.01), cavotricuspid isthmus-dependent flutter (8/27 vs. 17/195, p < 0.01), and other atrial tachycardias (15/27 vs. 33/195, p < 0.01). The SBS group also showed a higher incidence of ATAs requiring more complex treatment (10/27 vs. 14/195, p < 0.01).

SBS is associated with a higher incidence of non-PV-related ATAs, highlighting the need to consider this condition when planning procedural strategies for AF ablation.