CLINICAL RESEARCH: CARDIAC RHYTHM DISORDERS
Predictors of Non-Pulmonary Vein Ectopic Beats Initiating Paroxysmal Atrial Fibrillation
Implication for Catheter Ablation
Shih-Huang Lee, MD*, , ,*,
Ching-Tai Tai, MD*, ,
Ming-Hsiung Hsieh, MD,
Hsuan-Ming Tsao, MD,
Yenn-Jiang Lin, MD,
Shih-Lin Chang, MD,
Jin-Long Huang, MD*,
Kun-Tai Lee, MD,
Yi-Jen Chen, MD,
Jun-Jack Cheng, MD, and
Shih-Ann Chen, MD*,
* Department of Medicine, National Yang-Ming University, Taipei, Taiwan
Fu Jen Catholic University, Hsinchuang, Taipei Hsien, Tawain
Division of Cardiology, Veterans General Hospital-Taipei, Taipei, Taiwan
Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
Manuscript received March 25, 2005;
revised manuscript received May 23, 2005,
accepted May 31, 2005.
* Reprint requests and correspondence: Dr. Shih-Huang Lee, Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin, Taipei, Taiwan, R.O.C (Email: shlee{at}aptg.net).
OBJECTIVES: The purpose of this study was to investigate the predictor of non-pulmonary vein (PV) ectopic beats initiating paroxysmal atrial fibrillation (PAF).
BACKGROUND: Non-PV ectopic beats can initiate PAF in some patients and play an important role in the recurrence of PAF after PV isolation. Information on the predictors of non-PV ectopic beats initiating PAF is unknown.
METHODS: This study included 293 patients (215 men and 78 women, age 60 ± 14 years) with clinically documented drug-refractory PAF. Of the 94 patients with non-PV ectopic beats initiating PAF, 38 (40%) patients had superior vena cava (SVC) ectopic beats and 32 (34%) had left atrial posterior free wall (LAPFW) ectopic beats.
RESULTS: In a univariate analysis, only female gender was related to the presence of non-PV (p = 0.016) and SVC ectopic beats (p = 0.012). Right atrial enlargement (p = 0.005) and left atrial enlargement (p < 0.001) were related to the presence of LAPFW ectopic beats. In a multivariate analysis, female gender (p = 0.043; odds ratio 2.00, 95% confidence interval [CI] 1.02 to 3.92) and left atrial enlargement (p = 0.007; odds ratio 2.34, 95% CI 1.27 to 4.32) could predict the presence of non-PV ectopic beats. Subgroup analysis showed that female gender could predict the presence of SVC ectopic beats (p = 0.039; odds ratio 2.14, 95% CI 1.04 to 4.43). In contrast, left atrial enlargement could predict the presence of LAPFW ectopic beats (p = 0.002; odds ratio 3.89, 95% CI 1.62 to 9.38).
CONCLUSIONS: The location of non-PV ectopic beats initiating PAF can be predicted by both gender and left atrial enlargement.
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Abbreviations and Acronyms
| | CS = coronary sinus | | CT = crista terminalis | | LAPFW = left atrial posterior free wall | | LOM = ligament of Marshall | | PAF = paroxysmal atrial fibrillation | | PV = pulmonary vein | | RF = radiofrequency | | SVC = superior vena cava |
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