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Bergonti M, Spera FR, Ferrero TG, Nsahlai M, Bonomi A, Boris W, Saenen J, Huybrechts W, Miljoen H, Vandaele L, Wittock A, Heidbuchel H, Valderrábano M, Rodríguez-Mañero M, Sarkozy A. Anterior mitral line in patients with persistent atrial fibrillation and anterior scar: A multicenter matched comparison-The MiLine study. Heart Rhythm 2023; 20:658-665. [PMID: 36640853 DOI: 10.1016/j.hrthm.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND The benefit of an anterior mitral line (AML) in patients with persistent atrial fibrillation (AF) and anterior atrial scar undergoing ablation has never been investigated. OBJECTIVE The purpose of this study was to evaluate the outcomes of AML in addition to standard treatment compared to standard treatment alone (no AML) in this subset of patients. METHODS Patients with persistent AF and anterior low-voltage zone (LVZ) treated with AML in 3 centers were retrospectively enrolled. The patients were matched in 1:1 fashion with patients having persistent AF and anterior LVZ who underwent conventional ablation in the same centers. Matching parameters were age, LVZ burden, and repeated ablation. Primary endpoint was AF/atrial tachycardia (AT) recurrence. RESULTS One hundred eight-six patients (age 66 ± 9 years; 34% women) were selected and divided into 2 matched groups. Bidirectional conduction block was achieved in 95% of AML. After median follow-up of 2 years, AF/AT recurrence occurred in 29% of the patients in the AML group vs 48% in the no AML group (log-rank P = .024). On Cox regression multivariate analysis, left atrial volume (hazard ratio [HR] 1.03; P = .006) and AML (HR 0.46; P = .003) were significantly associated with the primary endpoint. On univariate logistic regression, lower body mass index, older age, extensive anterior LVZ, and position of the left atrial activation breakthrough away from the AML were associated with first-pass AML block. CONCLUSION In this retrospective matched analysis of patients with persistent AF and anterior scar, AML in addition to standard treatment was associated with improved AF/AT-free survival compared to standard treatment alone.
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Affiliation(s)
- Marco Bergonti
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.
| | | | - Teba Gonzalez Ferrero
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Michelle Nsahlai
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Alice Bonomi
- Department of Clinical Science and Community Health, University of Milan at Centro Cardiologico Monzino, Milano, Italy
| | - Wim Boris
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Wim Huybrechts
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Hielko Miljoen
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Lien Vandaele
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Anouk Wittock
- Department of Anesthesiology, University Hospital Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium; Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Miguel Valderrábano
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Moises Rodríguez-Mañero
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium; Department GENCOR, University of Antwerp, Antwerp, Belgium
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Manole S, Budurea C, Pop S, Iliescu AM, Ciortea CA, Iancu SD, Popa L, Coman M, Szabó L, Coman V, Bálint Z. Correlation between Volumes Determined by Echocardiography and Cardiac MRI in Controls and Atrial Fibrillation Patients. Life (Basel) 2021; 11:life11121362. [PMID: 34947893 PMCID: PMC8707690 DOI: 10.3390/life11121362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022] Open
Abstract
Aims: We aimed to compare cardiac volumes measured with echocardiography (echo) and cardiac magnetic resonance imaging (MRI) in a mixed cohort of healthy controls (controls) and patients with atrial fibrillation (AF). Materials and methods: In total, 123 subjects were included in our study; 99 full datasets were analyzed. All the participants underwent clinical evaluation, EKG, echo, and cardiac MRI acquisition. Participants with full clinical data were grouped into 63 AF patients and 36 controls for calculation of left atrial volume (LA Vol) and 51 AF patients and 30 controls for calculation of left ventricular end-diastolic volume (LV EDV), end-systolic volume (ESV), and LV ejection fraction (LV EF). Results: No significant differences in LA Vol were observed (p > 0.05) when measured by either echo or MRI. However, echo provided significantly lower values for left ventricular volume (p < 0.0001). The echo LA Vol of all the subjects correlated well with that measured by MRI (Spearmen correlation coefficient r = 0.83, p < 0.0001). When comparing the two methods, significant positive correlations of EDV (all subjects: r = 0.55; Controls: r = 0.71; and AF patients: r = 0.51) and ESV (all subjects: r = 0.62; Controls: r = 0.47; and AF patients: r = 0.66) were found, with a negative bias for values determined using echo. For a subgroup of participants with ventricular volumes smaller than 49.50 mL, this bias was missing, thus in this case echocardiography could be used as an alternative for MRI. Conclusion: Good correlation and reduced bias were observed for LA Vol and EF determined by echo as compared to cardiac MRI in a mixed cohort of patients with AF and healthy volunteers. For the determination of volume values below 49.50 mL, an excellent correlation was observed between values obtained using echo and MRI, with comparatively reduced bias for the volumes determined by echo. Therefore, in certain cases, echocardiography could be used as a less expensive, less time-consuming, and contraindication free alternative to MRI for cardiac volume determination.
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Affiliation(s)
- Simona Manole
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Claudia Budurea
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Sorin Pop
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Alin M. Iliescu
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Cristiana A. Ciortea
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Stefania D. Iancu
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Loredana Popa
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihaela Coman
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - László Szabó
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Vasile Coman
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Zoltán Bálint
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-264-405-300; Fax: +40-264-591-906
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Packer M. Characterization, Pathogenesis, and Clinical Implications of Inflammation-Related Atrial Myopathy as an Important Cause of Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015343. [PMID: 32242478 PMCID: PMC7428644 DOI: 10.1161/jaha.119.015343] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Historically, atrial fibrillation has been observed in clinical settings of prolonged hemodynamic stress, eg, hypertension and valvular heart disease. However, recently, the most prominent precedents to atrial fibrillation are metabolic diseases that are associated with adipose tissue inflammation (ie, obesity and diabetes mellitus) and systemic inflammatory disorders (ie, rheumatoid arthritis and psoriasis). These patients typically have little evidence of left ventricular hypertrophy or dilatation; instead, imaging reveals abnormalities of the structure or function of the atria, particularly the left atrium, indicative of an atrial myopathy. The left atrium is enlarged, fibrotic and noncompliant, potentially because the predisposing disorder leads to an expansion of epicardial adipose tissue, which transmits proinflammatory mediators to the underlying left atrium. The development of an atrial myopathy not only leads to atrial fibrillation, but also contributes to pulmonary venous hypertension and systemic thromboembolism. These mechanisms explain why disorders of systemic or adipose tissue inflammation are accompanied an increased risk of atrial fibrillation, abnormalities of left atrium geometry and an enhanced risk of stroke. The risk of stroke exceeds that predicted by conventional cardiovascular risk factors or thromboembolism risk scores used to guide the use of anticoagulation, but it is strongly linked to clinical evidence and biomarkers of systemic inflammation.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX.,Imperial College London United Kingdom
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