Relationship between Effective Refractory Period and Inducibility of Atrial Fibrillation from the Superior Vena Cava after Pulmonary Vein Isolation

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Abstract
In terms of the pulmonary vein (PV), atrial fibrillation (AF) patients have a shorter effective refractory period (ERP) than those without AF and a large dispersion of the ERP. 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 PV isolation (PVI). 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 via three-dimensional electroanatomic mapping. The SIG had a significantly shorter average SVC-ERP (236.0 ± 25.2 versus 294.8 ± 36.8 ms, P < 0.001), whereas SVC-ERP dispersion was not significantly different (30.0 ± 25.4 versus 33.3 ± 20.1 ms, P = 0.56). Although the longer SVC diameter was significantly longer in the SIG (27.4 ± 4.3 versus 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). The SIG had a shorter SVC-ERP, whereas 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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