Relationship between effective refractory period and inducibility of
atrial fibrillation from the superior vena cava after pulmonary vein
isolation
Abstract
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.