Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy

Ki Hun Kim, Sanghamitra Mohanty, Prasant Mohanty, Chintan Trivedi, Eli Hamilton Morris, Pasquale Santangeli, Rong Bai, Amin Al-Ahmad, John David Burkhardt, Joseph G. Gallinghouse, Rodney Horton, Javier E. Sanchez, Shane Bailey, Patrick M. Hranitzky, Jason Zagrodzky, Soo G. Kim, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Mar 7 2017

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Hormone Replacement Therapy
Thyroid Hormones
Atrial Fibrillation
Veins
Catheter Ablation
Heart Atria
Atrial Appendage
Superior Vena Cava
Coronary Sinus
Pulmonary Veins
Mitral Valve
Isoproterenol
Cardiac Arrhythmias
Thyroid Gland
Body Mass Index
Logistic Models
Hormones
Recurrence
Survival

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Thyroid hormone

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy. / Kim, Ki Hun; Mohanty, Sanghamitra; Mohanty, Prasant; Trivedi, Chintan; Morris, Eli Hamilton; Santangeli, Pasquale; Bai, Rong; Al-Ahmad, Amin; Burkhardt, John David; Gallinghouse, Joseph G.; Horton, Rodney; Sanchez, Javier E.; Bailey, Shane; Hranitzky, Patrick M.; Zagrodzky, Jason; Kim, Soo G.; Di Biase, Luigi; Natale, Andrea.

In: Journal of Interventional Cardiac Electrophysiology, 07.03.2017, p. 1-7.

Research output: Contribution to journalArticle

Kim, KH, Mohanty, S, Mohanty, P, Trivedi, C, Morris, EH, Santangeli, P, Bai, R, Al-Ahmad, A, Burkhardt, JD, Gallinghouse, JG, Horton, R, Sanchez, JE, Bailey, S, Hranitzky, PM, Zagrodzky, J, Kim, SG, Di Biase, L & Natale, A 2017, 'Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy', Journal of Interventional Cardiac Electrophysiology, pp. 1-7. https://doi.org/10.1007/s10840-017-0234-x
Kim, Ki Hun ; Mohanty, Sanghamitra ; Mohanty, Prasant ; Trivedi, Chintan ; Morris, Eli Hamilton ; Santangeli, Pasquale ; Bai, Rong ; Al-Ahmad, Amin ; Burkhardt, John David ; Gallinghouse, Joseph G. ; Horton, Rodney ; Sanchez, Javier E. ; Bailey, Shane ; Hranitzky, Patrick M. ; Zagrodzky, Jason ; Kim, Soo G. ; Di Biase, Luigi ; Natale, Andrea. / Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy. In: Journal of Interventional Cardiac Electrophysiology. 2017 ; pp. 1-7.
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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.",
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T1 - Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy

AU - Kim, Ki Hun

AU - Mohanty, Sanghamitra

AU - Mohanty, Prasant

AU - Trivedi, Chintan

AU - Morris, Eli Hamilton

AU - Santangeli, Pasquale

AU - Bai, Rong

AU - Al-Ahmad, Amin

AU - Burkhardt, John David

AU - Gallinghouse, Joseph G.

AU - Horton, Rodney

AU - Sanchez, Javier E.

AU - Bailey, Shane

AU - Hranitzky, Patrick M.

AU - Zagrodzky, Jason

AU - Kim, Soo G.

AU - Di Biase, Luigi

AU - Natale, Andrea

PY - 2017/3/7

Y1 - 2017/3/7

N2 - 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.

AB - 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.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Thyroid hormone

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