Journal of arrhythmia · 2026
Association Between Left Ventricular Diastolic Dysfunction and Subsequent Detection of Sick Sinus Syndrome and Atrial Fibrillation in Patients With Unexplained Syncope.
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Sumiyoshi Hironobu, Hayashi Hidemori, Nakashima Akira, Kono Toshikazu, Ono Maki, Mizukami Akira, Minamino Tohru
Аннотация
BACKGROUND: Atrial fibrillation (AF) and sick sinus syndrome (SSS) frequently coexist and may share common atrial structural and electrophysiological remodeling substrates. Left ventricular (LV) diastolic dysfunction frequently coexists with AF; however, its association with subsequent detection of SSS and AF remains incompletely understood. This study investigated whether LV diastolic dysfunction is associated with the detection of SSS and AF.
METHODS: This study included patients who underwent insertable cardiac monitor implantation for recurrent unexplained syncope. Patients with prior AF, LV ejection fraction < 50%, or without remote monitoring were excluded. LV diastolic dysfunction was assessed using the HFA-PEFF score. The primary endpoints were SSS requiring pacemaker implantation and AF during follow-up.
RESULTS: Among 164 patients (median age 71 years; 34.1% women; median follow-up 35 months), SSS was detected in 31 patients (18.9%), and AF episodes lasting ≥ 6 min were detected in 48 patients (29.3%). Patients with high HFA-PEFF scores (5, 6) had a significantly higher risk of detection of SSS and AF. The HFA-PEFF score remained independently associated with SSS (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.07-2.13; p = 0.021) and AF lasting ≥ 6 min (HR, 1.94; 95% CI, 1.40-2.67; p < 0.001) after multivariable adjustment.
CONCLUSION: LV diastolic dysfunction, as quantified by the HFA-PEFF score, is independently associated with the detection of SSS and AF, suggesting a potential association between LV diastolic dysfunction and arrhythmogenic atrial remodeling substrates.
METHODS: This study included patients who underwent insertable cardiac monitor implantation for recurrent unexplained syncope. Patients with prior AF, LV ejection fraction < 50%, or without remote monitoring were excluded. LV diastolic dysfunction was assessed using the HFA-PEFF score. The primary endpoints were SSS requiring pacemaker implantation and AF during follow-up.
RESULTS: Among 164 patients (median age 71 years; 34.1% women; median follow-up 35 months), SSS was detected in 31 patients (18.9%), and AF episodes lasting ≥ 6 min were detected in 48 patients (29.3%). Patients with high HFA-PEFF scores (5, 6) had a significantly higher risk of detection of SSS and AF. The HFA-PEFF score remained independently associated with SSS (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.07-2.13; p = 0.021) and AF lasting ≥ 6 min (HR, 1.94; 95% CI, 1.40-2.67; p < 0.001) after multivariable adjustment.
CONCLUSION: LV diastolic dysfunction, as quantified by the HFA-PEFF score, is independently associated with the detection of SSS and AF, suggesting a potential association between LV diastolic dysfunction and arrhythmogenic atrial remodeling substrates.