{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T02:39:25Z","timestamp":1777516765964,"version":"3.51.4"},"reference-count":13,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T00:00:00Z","timestamp":1663632000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Even a short duration of paroxysmal episodes of atrial fibrillation (AF) is associated with sinus node (SN) remodeling and a reduced SN reserve or dysfunction. The number of earliest atrial activation sites (EASs) during sinus rhythm decreases according to the decrease in the SN reserve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We sought to evaluate the EASs during sinus rhythm using an ultrahigh\u2010density mapping system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included 35 patients (supraventricular tachycardia [SVT]\/paroxysmal atrial fibrillation [PAF]\/persistent atrial fibrillation [PsAF]\u2009=\u20095\/21\/9) who underwent ultrahigh\u2010resolution endocardial mapping of the SN area at rest and during \u03b2\u2010stimulation. The number of EASs was determined by the Lumipoint\u2122 algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The number of EASs was greatest in SVT patients both at rest (SVT\/PAF\/PsAF\u2009=\u20091.4\u2009\u00b1\u20090.8\/1.0\u2009\u00b1\u20090\/1.0\u2009\u00b1\u20090, <jats:italic>p<\/jats:italic>\u2009=\u2009.04) and during \u03b2\u2010stimulation (SVT\/PAF\/PsAF\u2009=\u20092.6\u2009\u00b1\u20091.0\/1.3\u2009\u00b1\u20090.6\/1.0\u2009\u00b1\u20090, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). The number significantly increased with \u03b2\u2010stimulation as compared to baseline in the PAF patients (<jats:italic>p<\/jats:italic>\u2009=\u2009.02), but not in the PsAF patients. The brain natriuretic peptide (BNP) level was significantly higher in AF than SVT patients (SVT\/PAF\/PsAF\u2009=\u200912.3 [10.1\u201314.5]\/25.7 [14.8\u201336.0]\/73.4 [57.6\u2013140]\u2009pg\/ml, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). In the PAF patients, the BNP level was significantly higher in those with unicentric EASs than multicentric EASs during \u03b2\u2010stimulation (28.1 [19.1\u201346.5] vs. 13.1 [9.4\u201326.9]\u2009pg\/ml, <jats:italic>p<\/jats:italic>\u2009=\u2009.03), and the optimal cutoff point for the BNP level predicting unicentric EASs was 21.8\u2009pg\/ml (sensitivity 82.6%; specificity 85.7%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>AF patients have a smaller number of EASs and poorer response to \u03b2\u2010stimulation than non\u2010AF patients. An elevated BNP level might predict subclinical SN dysfunction in patients with PAF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15673","type":"journal-article","created":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T04:59:05Z","timestamp":1663217945000},"page":"2599-2605","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Subclinical sinus node dysfunction in patients with atrial fibrillation\u2014Insight from ultrahigh\u2010resolution mapping of human sinoatrial exits"],"prefix":"10.1111","volume":"33","author":[{"given":"Tomoya","family":"Eguchi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0230-0934","authenticated-orcid":false,"given":"Shinsuke","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshihiko","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moeko","family":"Nagao","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shota","family":"Kakehashi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moe","family":"Mukai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Sekihara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisetsu","family":"Aoyama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minoru","family":"Nodera","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fukushima Medical University Fukushima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanae","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyasu","family":"Uzui","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Tada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Fukui Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000090685.13169.07"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.11.054"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.111.965897"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.018011"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.098"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00892.2011"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540-8167.2002.00020.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu276"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.05.012"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2015.06.002"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.77.6.1221"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540-8167.2004.03403.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12852"}],"container-title":["Journal 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