Ki-Hun Kim1, Sanghamitra Mohanty2,3, Prasant Mohanty2, Chintan Trivedi2, Eli Hamilton Morris4, Pasquale Santangeli4, Rong Bai2,5, Amin Al-Ahmad2, John David Burkhardt2, Joseph G Gallinghouse2, Rodney Horton2,6, Javier E Sanchez2, Shane Bailey2, Patrick M Hranitzky2, Jason Zagrodzky2, Soo G Kim7, Luigi Di Biase2,6,7,8, Andrea Natale9,10,11,12. 1. Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. 2. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, 78705, USA. 3. Dell Medical School, Austin, TX, USA. 4. University of Pennsylvania, Pennsylvania, USA. 5. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 6. Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA. 7. Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY, USA. 8. Department of Cardiology, University of Foggia, Foggia, Italy. 9. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, 78705, USA. dr.natale@gmail.com. 10. Dell Medical School, Austin, TX, USA. dr.natale@gmail.com. 11. Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA. dr.natale@gmail.com. 12. California Pacific Medical Center, San Francisco, CA, USA. dr.natale@gmail.com.
Abstract
BACKGROUND: Thyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known. METHODS: This study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation. A total of 146 patients on THR and 146 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model (age, sex, body mass index, and left atrium size). The presence of non-pulmonary vein (PV) triggers was disclosed by a high-dose isoproterenol challenge (up to 30 μg/min) after PV isolation. RESULTS: Clinical characteristics were not different between the groups. When compared to the control, non-PV triggers were significantly greater in the THR patients [112 (77%) vs. 47 (32%), P < 0.001], and most frequently originated from the right atrium (95 vs. 56%, P < 0.001). Other sources of non-PV triggers were the interatrial septum (25 vs. 11%, P = 0.002), coronary sinus (70 vs. 52%, P = 0.01), left atrial appendage (47 vs. 34%, P = 0.03), crista terminalis/superior vena cava (11 vs. 8%, P = 0.43), and mitral valve annulus (7 vs. 5%, P = 0.45) (THR vs. control), respectively. After mean follow-up of 14.7 ± 5.2 months, success rate was lower in patients on THR therapy [94 (64.4%)] compared to patients not receiving THR therapy [110 (75.3%), log-rank test value = 0.04]. CONCLUSIONS: Right atrial non-PV triggers were more prevalent in AF patients treated with THR. Elimination of non-PV triggers provided better arrhythmia-free survival in the non-THR group.
BACKGROUND: Thyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known. METHODS: This study evaluated 1163 consecutive paroxysmal AFpatients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation. A total of 146 patients on THR and 146 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model (age, sex, body mass index, and left atrium size). The presence of non-pulmonary vein (PV) triggers was disclosed by a high-dose isoproterenol challenge (up to 30 μg/min) after PV isolation. RESULTS: Clinical characteristics were not different between the groups. When compared to the control, non-PV triggers were significantly greater in the THRpatients [112 (77%) vs. 47 (32%), P < 0.001], and most frequently originated from the right atrium (95 vs. 56%, P < 0.001). Other sources of non-PV triggers were the interatrial septum (25 vs. 11%, P = 0.002), coronary sinus (70 vs. 52%, P = 0.01), left atrial appendage (47 vs. 34%, P = 0.03), crista terminalis/superior vena cava (11 vs. 8%, P = 0.43), and mitral valve annulus (7 vs. 5%, P = 0.45) (THR vs. control), respectively. After mean follow-up of 14.7 ± 5.2 months, success rate was lower in patients on THR therapy [94 (64.4%)] compared to patients not receiving THR therapy [110 (75.3%), log-rank test value = 0.04]. CONCLUSIONS: Right atrial non-PV triggers were more prevalent in AFpatients treated with THR. Elimination of non-PV triggers provided better arrhythmia-free survival in the non-THR group.
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