Key result
A shorter superior vena cava effective refractory period was significantly associated with pacing inducibility of atrial fibrillation after pulmonary vein isolation (OR 0.96, p=0.01).
Why the study?
Although the superior vena cava is the most frequent non-pulmonary vein focus for AF, the characteristics of the superior vena cava effective refractory period and its relationship to AF inducibility after PVI were unclear.
Is a shorter effective refractory period in the superior vena cava associated with increased inducibility of atrial fibrillation after pulmonary vein isolation?
Observational (n=28)
Is a shorter effective refractory period in the superior vena cava associated with increased inducibility of atrial fibrillation after pulmonary vein isolation?
A shorter effective refractory period in the superior vena cava is associated with increased inducibility of atrial fibrillation from the SVC after pulmonary vein isolation.
Answers are grounded in this paper and cite their sources.
Shorter SVC-ERP was associated with post-PVI AF inducibility from the SVC; hypothesis-generating for selective isolation strategies.
Background: In terms of the pulmonary vein (PV), atrial fibrillation (AF) patients have a shorter effective refractory period (ERP) and a larger dispersion of the ERP than patients without AF. Although the frequency of AF from the superior vena cava (SVC) was the highest among non-PV foci, the characteristics of the ERP in the SVC (SVC-ERP) were unclear. The purpose of this study was to elucidate the relationship between SVC-ERP and the inducibility of AF after pulmonary vein isolation (PVI). Methods and Results: Consecutive 28 patients who underwent PVI were included. After successful PVI, the SVC-ERP was measured at three positions in SVC. Rapid electrical stimuli were delivered at the shortest SVC-ERP to induce AF. Patients in whom AF was induced were assigned to the SVC-induced group (SIG) and the remaining patients were the non-SVC-induced group (non-SIG). The size of the SVC sleeve was evaluated using three-dimensional electroanatomic mapping. The SIG had a significantly shorter average SVC-ERP (236.0±25.2 vs. 294.8±36.8 ms, p<0.001), while SVC-ERP dispersion was not significantly different (30.0±25.4 vs. 33.3±20.1 ms, p=0.56). Although the longer SVC diameter was significantly longer in the SIG (27.4±4.3 vs. 22.9±4.6 mm, p=0.03), the SVC-ERP was significantly associated with pacing inducibility of AF after adjustment for the longer SVC diameter (odds ratio: 0.96 [1-ms increments], p=0.01). Conclusions: The SIG had a shorter SVC-ERP, while the dispersion was not significantly different between the two groups. The SVC-ERP can be one of the mechanisms of arrhythmogenicity for AF originating from the SVC.
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Yamagishi et al. (2021) conducted an observational in Atrial fibrillation (n=28). Superior vena cava effective refractory period (SVC-ERP) vs. Non-SVC-induced group (non-SIG) was evaluated on Pacing inducibility of atrial fibrillation (OR 0.96, p=0.01). A shorter superior vena cava effective refractory period was significantly associated with pacing inducibility of atrial fibrillation after pulmonary vein isolation (OR 0.96, p=0.01).
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