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Mărgulescu AD, Mas-Lladó C, Prat-Gonzàlez S, Perea RJ, Borras R, Benito E, Alarcón F, Guasch E, Tolosana JM, Arbelo E, Sitges M, Brugada J, Mont L. Combined Area of Left and Right Atria May Outperform Atrial Volumes as a Predictor of Recurrences after Ablation in Patients with Persistent Atrial Fibrillation-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:151. [PMID: 38256411 PMCID: PMC10818489 DOI: 10.3390/medicina60010151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Left atrial (LA) remodelling and dilatation predicts atrial fibrillation (AF) recurrences after catheter ablation. However, whether right atrial (RA) remodelling and dilatation predicts AF recurrences after ablation has not been fully evaluated. Materials and Methods: This is an observational study of 85 consecutive patients (aged 57 ± 9 years; 70 [82%] men) who underwent cardiac magnetic resonance before first catheter ablation for AF (40 [47.1%] persistent AF). Four-chamber cine-sequence was selected to measure LA and RA area, and ventricular end-systolic image phase to obtain atrial 3D volumes. The effect of different variables on event-free survival was investigated using the Cox proportional hazards model. Results: In patients with persistent AF, combined LA and RA area indexed to body surface area (AILA + RA) predicted AF recurrences (HR = 1.08, 95% CI 1.00-1.17, p = 0.048). An AILA + RA cut-off value of 26.7 cm2/m2 had 72% sensitivity and 73% specificity for predicting recurrences in patients with persistent AF. In this group, 65% of patients with AILA + RA > 26.7 cm2/m2 experienced AF recurrence within 2 years of follow-up (median follow-up 11 months), compared to 25% of patients with AILA + RA ≤ 26.7 cm2/m2 (HR 4.28, 95% CI 1.50-12.22; p = 0.007). Indices of LA and RA dilatation did not predict AF recurrences in patients with paroxysmal AF. Atrial 3D volumes did not predict AF recurrences after ablation. Conclusions: In this pilot study, the simple measurement of AILA + RA may predict recurrences after ablation of persistent AF, and may outperform measurements of atrial volumes. In paroxysmal AF, atrial dilatation did not predict recurrences. Further studies on the role of RA and LA remodelling are needed.
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Affiliation(s)
| | - Caterina Mas-Lladó
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
| | - Susanna Prat-Gonzàlez
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Rosario Jesus Perea
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Roger Borras
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Eva Benito
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Francisco Alarcón
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Eduard Guasch
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Jose María Tolosana
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Elena Arbelo
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Marta Sitges
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Josep Brugada
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Lluís Mont
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
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Ma G, Fang L, Lin X, Gao P, Fang Q. Validation of E/e' Using the Index-Beat Method as an Estimate of Left Atrial Pressure in Patients with Atrial Fibrillation. Cardiology 2023; 148:418-426. [PMID: 37517396 DOI: 10.1159/000532071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Echocardiographic assessment of diastolic function during atrial fibrillation (AF) remains challenging due to the irregular cardiac cycle length. We sought to assess whether the index-beat method, the beat following two preceding cardiac cycles of equal duration, could provide a more reliable measurement of E/e' (mitral E wave/diastolic tissue Doppler velocity) than the conventional averaging of consecutive beats and hence facilitate the noninvasive estimation of elevated left atrial pressure (LAP) in patients with AF. METHODS We prospectively studied 35 patients with persistent AF who had preserved left ventricular ejection fraction and underwent radiofrequency ablation. LAP was measured in conjunction with transseptal puncture during catheter ablation. Echocardiography was performed 24 h before ablation and E/e' was determined using the recommended averaging of 10 beats and the index-beat method, with the observers blinded to the clinical details and LAP measurements. RESULTS Correlation analysis showed a strong positive correlation between two methods in terms of both septal E/e' (r = 0.841, p < 0.001) and lateral E/e' (r = 0.930, p < 0.001). Bland-Altman analysis also showed a good agreement between the two measurement methods in terms of E/e'. E/e' determined using both conventional averaging and the index-beat method was significantly correlated with LAP (p < 0.05). After Fisher Z transformation, we found that the index-beat septal E/e' had a better correlation with LAP than did the conventional averaging E/e' (r = 0.736 vs. r = 0.392, Zr = -2.110, p = 0.035). Furthermore, the index-beat method took significantly less time to measure E/e' (mean 33.6 s; 95% confidence intervals [CIs]: 32.1 s-36.2 s) than did conventional averaging method (mean 96.2 s; 95% CI: 90.2 s-102.3 s; p < 0.001). Receiver operating characteristic curve analysis revealed that the optimal cut-off for predicting mean LAP >12 mm Hg was 11 (sensitivity 100%; specificity 77.3%) for index-beat septal E/e' and 16 (sensitivity 61.5%; specificity 95.5%) for index-beat lateral E/e'. CONCLUSIONS Good correlations were found between E/e' and LAP in patients with AF, particularly with the index-beat method. Moreover, the index-beat method can easily measure E/e' at an accuracy similar to that for the conventional averaging of consecutive beats, which can therefore be applied to assess the diastolic dysfunction and potentially improve the diagnosis of heart failure in patients with AF.
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Affiliation(s)
- Gaigai Ma
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Gao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Zhao D, Zhang F, Liu X, Li M, Zhang L, Hu J, Li F, Wu J. Efficacy of catheter ablation for atrial fibrillation in patients with significant functional mitral regurgitation. Medicine (Baltimore) 2023; 102:e33231. [PMID: 36897680 PMCID: PMC9997827 DOI: 10.1097/md.0000000000033231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Catheter ablation has been established to be an effective therapy for paroxysmal atrial fibrillation (AF) and is recommended as the treatment of choice for many patients, including those with clinically significant functional mitral regurgitation (MR). However, there is little information available about the clinical efficacy of catheter ablation for paroxysmal AF in patients with significant functional MR. METHODS We performed a retrospective study of 247 patients with paroxysmal AF who underwent AF ablation. The study included 28 (11.3%) patients with significant functional MR and 219 (88.7%) without significant functional MR. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting >30 seconds beyond 3 months after catheter ablation. RESULTS During a mean follow-up of 20.1 ± 7.4 months (range, 3-36 months), 45 (18.2%) patients developed recurrence of AF. The recurrence rate of AF was higher in patients with significant functional MR than in those without significant functional MR (42.9% vs 15.1%; P < .001). Univariable Cox proportional hazards regression analysis showed that significant functional MR (hazard ratio [HR], 3.46; 95% confidence interval [CI], 1.78-6.72; P < .001), age (HR, 1.04; 95% CI, 1.01-1.08; P = .009), the CHA2DS2-VASc score (HR, 1.28; 95% CI, 1.05-1.56; P = .017), and heart failure (HR, 4.71; 95% CI, 1.85-11.96; P = .001) were associated with the risk of recurrence. Multivariable analysis showed that significant functional MR (HR, 2.48; 95% CI, 1.21-5.05; P = .013), age (HR, 1.04; 95% CI, 1.00-1.07; P = .031), and heart failure (HR, 3.39; 95% CI, 1.27-9.03; P = .015) were independent predictors of AF recurrence. CONCLUSION Patients with significant functional MR have an increased risk of AF recurrence after catheter ablation.
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Affiliation(s)
- Danqing Zhao
- Department of Cardiology, Anyang People’s Hospital, Anyang, China
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Futao Zhang
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Xiaojie Liu
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Muzhang Li
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Central China Fuwai Hospital, Zhengzhou, China
| | - Leiming Zhang
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Hu
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Li
- Human Resource Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jintao Wu
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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Relationship between left ventricular diastolic function and the risk of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Int J Cardiovasc Imaging 2023; 39:35-42. [PMID: 36598680 DOI: 10.1007/s10554-022-02690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023]
Abstract
In patients with nonvalvular atrial fibrillation (NVAF), the impact of left ventricular diastolic function on the risk of left atrial appendage (LAA) thrombus has rarely been studied. This prospective study aimed to investigate the relationship between diastolic function and the risk of LAA thrombus in patients with NVAF. Seventy-six patients with NVAF admitted to receive radiofrequency catheter ablation were prospectively enrolled. All the patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in 24 h before ablation. Diastolic function was estimated by TTE including left atrial volume index (LAVI) and E/e', as well as invasive left atrial pressure (LAP) measured during the ablation procedure. LAA peak emptying velocity (LAA-PEV) and the intensity of spontaneous echo contrast (SEC) were determined by TEE. Average E/e', LAVI and mean LAP had a significant positive correlation with the intensity of SEC, the coefficient of correlation were 0.344 (p = 0.002), 0.416 (p < 0.001) and 0.402 (p < 0.001), respectively. After adjustment for CHA2DS2-VASc score and type of AF, multivariate regression analysis revealed that increased LAP (OR 1.144, 95% CI 1.012-1.293, p = 0.031) independently correlated with the risk of LAA thrombus (SEC ≥ Grade 2). LAA-PEV showed a significantly inverse relationship with mean LAP in patients with AF (r = - 0.525, p < 0.001), and in the assessment of elevated LAP with TEE, the LAA-PEV cut-off of 0.40 m/s had a sensitivity of 80%, specificity of 81%. Left ventricular diastolic dysfunction may constitute a potential risk for LAA thrombus and stroke. Furthermore, evaluation of LAA emptying with use of TEE is helpful for assessing the LAP status of patients with AF.
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MANFRIN M, MUGNAI G, CHIERCHIA GB, de ASMUNDIS C, BILATO C, RAUHE W. Left atrial hypertension invasively measured during pulmonary vein isolation predicts atrial fibrillation recurrence. Minerva Cardiol Angiol 2022; 70:529-536. [DOI: 10.23736/s2724-5683.20.05418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kim MH, Yu HT, Park YJ, Kim TH, Joung B, Lee MH, Pak HN. Diabetes Mellitus Is an Independent Risk Factor for a Stiff Left Atrial Physiology After Catheter Ablation for Atrial Fibrillation. Front Cardiovasc Med 2022; 9:828478. [PMID: 35419435 PMCID: PMC8995895 DOI: 10.3389/fcvm.2022.828478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Scar tissue formation after catheter ablation for atrial fibrillation (AF) may adversely affect the diastolic properties of the left atrium (LA), which can result in a stiff LA physiology in a small proportion of patients. In this study, we aimed to explore the relationship between diabetes mellitus and a stiff LA physiology after AF catheter ablation (AFCA). Methods A total of 1,326 patients who underwent de novo AFCA, and baseline and 1-year follow-up echocardiographies were enrolled. After 1:3 propensity score (PS) matching for age, sex, and AF type, we compared 211 patients with DM with 633 patients without DM. A stiff LA physiology was defined as estimated pulmonary arterial pressure increase of >10 mmHg and a right ventricular systolic pressure of >35 mmHg at 1-year follow-up echocardiography. Pulmonary vascular resistance (PVR) was estimated using echocardiographic parameters. Results Among the 844 PS-matched patients, a stiff LA physiology was observed in 32 patients (4.1%). The patients with DM showed a higher peak LA pressure (p < 0.001) and greater LA wall stress (p = 0.001) than did those without. A stiff LA physiology was independently associated with DM [Odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.02-5.59, p = 0.045], empirical extra-pulmonary vein LA ablation (OR = 3.14, 95% CI 1.07–9.3, p = 0.038) and the ΔPVR (OR = 1.78, 95% CI 1.37–2.31, p < 0.001). The ΔPVR was independently associated with DM (β = 0.37, 95% CI 0.06-0.67, p = 0.020) and a stiff LA physiology (β = 1.40, 95% CI 0.70–2.10, p < 0.001). During the 38.8 ± 29.3months follow-up, the incidence of the clinical recurrence of AF was significantly higher in the patients with a stiff LA physiology than in those without (log rank p = 0.032). Conclusion A stiff LA physiology was independently associated with DM because of the relatively small decrease in the PVR after AFCA in this population. The patients with a stiff LA physiology had worse rhythm outcomes after AFCA than those without.
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Bak M, Jeong DS, Park S, Park B, Seo JH, Park I, Kim J, Chung SR, Kim EK, Sung K. Predictor of atrial fibrillation recurrence in patients who underwent a tricuspid valve operation with modified Cox maze procedure. Echocardiography 2022; 39:447-456. [DOI: 10.1111/echo.15315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Minjung Bak
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Sung‐Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Boram Park
- Statistics and Data Center Samsung Medical Center Seoul Republic of Korea
| | - Jeong Hun Seo
- Division of Cardiology, Department of Internal Medicine Kangwon National University Hospital Chuncheon‐si Gangwon‐do Republic of Korea
| | - Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Su Ryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Baimbetov AK, Bizhanov KA, Abzaliyev KB, Bairamov BA, Yakupova IA. Prediction of arrhythmia recurrence after atrial fibrillation ablation in patients with normal anatomy of the left atrium. Int J Clin Pract 2021; 75:e14083. [PMID: 33555091 DOI: 10.1111/ijcp.14083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Enlarged left atrium is an established predictor of atrial fibrillation recurrence after pulmonary vein isolation but arrhythmia recurrence is also observed in patients with normal anatomy of the left atrium. The aim of the study is to evaluate arrhythmia recurrence predictors in patients with normal anatomy of the left atrium. METHODS The study included 182 patients with normal anatomy of the left atrium who underwent pulmonary vein isolation using catheter ablation. Various parameters were also compared, including age, gender, history of arrhythmia, arterial hypertension, concomitant coronary pathology, echocardiography findings, such as mitral valve and tricuspid valve regurgitation and procedure parameters, between patients with and without relapses. Statistical analysis was performed using the IBM SPSS Statistics-19 software. RESULTS Transthoracic echocardiography was performed by independent specialists with extensive experience. Trans-esophageal echocardiography was performed before each ablation procedure. Standard trans-septal puncture was performed under fluoroscopic control. Radiofrequency ablation was performed in the ipsilateral pulmonary vein antrum with a wide capture of nearby lung tissue. CONCLUSIONS It was concluded that the tricuspid valve regurgitation and arterial hypertension correlate with atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial anatomy.
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Affiliation(s)
- Adil K Baimbetov
- Department of Interventional Cardiology and Arrhythmology, National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Republic of Kazakhstan
| | - Kenzhebek A Bizhanov
- Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan
| | - Kuat B Abzaliyev
- Department of Clinical Specialties, Higher School of Medicine, Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan
| | - Binali A Bairamov
- Department of Interventional Cardiology and Arrhythmology, National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Republic of Kazakhstan
| | - Ilinara A Yakupova
- Department of Interventional Cardiology and Arrhythmology, National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Republic of Kazakhstan
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Okada M, Tanaka N, Tanaka K, Hirao Y, Yoshimoto I, Harada S, Onishi T, Koyama Y, Okamura A, Iwakura K, Fujii K, Sakata Y, Inoue K. Usefulness of Post-Procedural Plasma Brain Natriuretic Peptide Levels to Predict Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Left Ventricular Systolic Dysfunction. Am J Cardiol 2021; 144:67-76. [PMID: 33385358 DOI: 10.1016/j.amjcard.2020.12.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023]
Abstract
Catheter ablation (CA) of atrial fibrillation (AF) improves cardiac function, resulting in a decrease in plasma brain natriuretic peptide (BNP) levels in patients with reduced left ventricular ejection fraction (LVEF). This study sought to examine the pre-procedural and post-procedural correlations between BNP levels and cardiac function and the associations between the BNP levels and recurrence after CA in patients with AF and reduced LVEF. Of 3142 consecutive patients who underwent first-time CA of AF at our institute, a total of 217 patients with LVEF <50% were enrolled. Significant decrease in BNP levels (from a median of 198 [interquartile range 113 to 355] to 47.7 [22.7 to 135] pg/ml, p <0.001) and improvement in LVEF (from 39±9% to 61±16%, p <0.001) were observed 3 months after CA. There was a linear correlation between log-transformed BNP levels and cardiac measures (LVEF: r = -0.64; LV end-diastolic volume: r = 0.25; LV end-systolic volume: r = 0.43; left atrial volume: r = 0.52; all p <0.001). During a median follow-up of 35 months, AF recurrence after a 3-month blanking period was observed in 80 patients (37%). Cox proportional hazard regression analysis after adjustment for cardiac measures significant in univariate analysis revealed that early recurrence within the blanking period (hazard ratio, 4.88; 95% confidence interval, 2.89 to 8.25) and elevated post-procedural BNP levels (2.02 per unit log increase; 1.14 to 3.56) were significant predictors of AF recurrence, but pre-procedural BNP was not. In conclusion, post-procedural BNP levels at the end of the blanking period predicted subsequent AF recurrence in patients with reduced LVEF, independent of early recurrence.
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The Predictive Value of Growth Differentiation Factor-15 in Recurrence of Atrial Fibrillation after Catheter Ablation. Mediators Inflamm 2020; 2020:8360936. [PMID: 32904560 PMCID: PMC7456492 DOI: 10.1155/2020/8360936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022] Open
Abstract
The mechanisms underlying the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are not well concerned. The study sought to explore the association between growth differentiation factor-15 (GDF-15) and the incidence of recurrent events among AF patients after the ablation procedure. We prospectively included 150 consecutive AF patients who underwent RFCA. Clinical information about the patients was collected. Blood samples on the second morning of hospital admission and three months after RFCA were collected, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of GDF-15. All participants were followed up at specific times (1st/3rd/6th/12th/18th/24th months) after RFCA to record recurrences events. During a median follow-up of 14.0 months, AF recurrence occurred in 37(24.7%) patients. Baseline serum GDF-15 level in the persistent AF group was significantly higher than the paroxysmal AF group [1140(854~1701)ng/L vs. 1062(651~1374)ng/L, P = 0.039]. Baseline serum GDF-15 level in the recurrence group was significantly higher than the nonrecurrence group [1287(889~1768) ng/L vs. 1062(694~1373)ng/L, P = 0.022]. Serum GDF-15 level at three months after RFCA was significantly lower than the baseline [870 (579~1270) ng/L vs. 1155 (735~1632)ng/L, P < 0.001]. The baseline GDF-15 correlated significantly with LAP (r = 0.296, P < 0.001) and LAAV(r = −0.235, P = 0.003). Kaplan-Meier analysis showed a significantly lower event-free survival time in the high baseline GDF-15 (≥1287.3 ng/L) group than the low baseline GDF-15 (<1287.3 ng/L) group (17.1 months vs. 20.4 months, Log Rank P = 0.017). In the multivariate Cox regression, baseline GDF-15(HR 1.053, 95% CI 1.007-1.100, P = 0.022) and LAD (HR 1.124, 95% CI 1.011-1.250, P = 0.030) were independent predictors of AF recurrence after RFCA. Our study indicated increased preprocedural GDF-15 is associated with left atrial remodeling and acts as a predictor of AF recurrence after ablation.
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Yano M, Egami Y, Yanagawa K, Matsuhiro Y, Nakamura H, Yasumoto K, Okamoto N, Tanaka A, Matsunaga‐Lee Y, Nakamura D, Yamato M, Shutta R, Nishino M, Tanouchi J. Predictors of recurrence after pulmonary vein isolation in patients with normal left atrial diameter. J Arrhythm 2020; 36:75-81. [PMID: 32071623 PMCID: PMC7011825 DOI: 10.1002/joa3.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/06/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Enlarged left atrium (LA) is an established predictor of recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI), but occasionally recurrences of AF/atrial tachycardia (AT) are experienced in patients with normal left atrial diameter. Therefore, the predictors of AF recurrence and AF triggers were evaluated in patients with normal LA. METHODS We enrolled 168 patients with normal LA (<40 mm) who underwent PVI. Various predictors were compared, including age, gender, coronary risk factors, brain natriuretic peptide (BNP), medications, echocardiographic parameters, and procedure parameters, between recurrence and nonrecurrence groups. RESULTS The recurrence group consisted of 50 patients (29.8%). A univariate analysis demonstrated that the ratio of females, high BNP levels, severe tricuspid valve regurgitation (TR), and relapses of AF/AT during catheter ablation (CA) were significantly higher in the recurrence group. Multivariate analyses showed that a high BNP, severe TR, and AF/AT relapses during CA were independent factors associated with AF recurrence. During the second CA sessions, nonpulmonary vein (PV) triggers were therapeutic targets in 18 patients (46.2%), which was higher than that previously reported. CONCLUSION A high BNP, severe TR and AF/AT relapses during CA may be correlated with AF recurrence after PVI in the patients with normal LA.
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Affiliation(s)
| | | | | | | | | | - Koji Yasumoto
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
| | | | | | | | | | - Masaki Yamato
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
| | - Ryu Shutta
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
| | | | - Jun Tanouchi
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
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12
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Masai K, Kishima H, Takahashi S, Ashida K, Goda A, Mine T, Asakura M, Ishihara M, Masuyama T. Interatrial septal motion as a novel index to predict left atrial pressure. Heart Vessels 2018; 33:762-769. [PMID: 29357094 DOI: 10.1007/s00380-017-1112-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 12/22/2017] [Indexed: 11/26/2022]
Abstract
We investigated whether the interatrial septal (IAS) motion of each heartbeat which is observed by transesophageal echocardiography reflects left atrial pressure (LAP) in patients with atrial fibrillation (AF). We studied 100 patients (70 males, age 67 ± 9 years) who underwent catheter ablation for AF. The amplitude of IAS motion was measured using M-mode and averaged for five cardiac cycles. Left and right atrial pressures, the left to right atrial pressure gradient were directly measured during the catheter ablation. In patients with sinus rhythm during measurement, elevated mean LAP, larger maximum left to right atrial pressure gradient, and greater left atrial emptying fraction were associated with IAS motion. The optimal cut-off value of the IAS motion for predicting high LAP (mean LAP > 15 mmHg) was 8.5 mm (sensitivity 100%, specificity 70.1%) in patients with sinus rhythm during pressure measurement. In addition, all patients were divided into 6 groups based on rhythm during measurement and cutoff value of IAS motion. In patients with sinus rhythm during measurement, low IAS motion group had a highest prevalence of elevated LAP compared with high IAS motion group (64 vs. 0%, P < 0.0001). The amplitude of interatrial septal motion during sinus rhythm reflects left atrial pressure in patients with atrial fibrillation. Interatrial septal motion could be a new index to predict elevated left atrial pressure.
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Affiliation(s)
- Kumiko Masai
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Hideyuki Kishima
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Satoshi Takahashi
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Kenki Ashida
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Akiko Goda
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Takanao Mine
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Masanori Asakura
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Masaharu Ishihara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
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Beiert T, Lodde PC, Linneborn LP, Werner J, Prinz L, Stöckigt F, Linhart M, Lickfett L, Nickenig G, Schrickel JW, Andrié RP. Outcome in patients with left common pulmonary vein after cryoablation with second-generation cryoballoon. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:22-27. [DOI: 10.1111/pace.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/18/2017] [Accepted: 11/26/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Thomas Beiert
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Pia C. Lodde
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lutz P.T. Linneborn
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Jessica Werner
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lisa Prinz
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Florian Stöckigt
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Markus Linhart
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Lars Lickfett
- Clinic for Cardiology and Pneumology; Mönchengladbach Germany
| | - Georg Nickenig
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Jan W. Schrickel
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - René P. Andrié
- Department of Internal Medicine II; University Hospital Bonn; Rheinische Friedrich-Wilhelms University; Bonn Germany
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Kishima H, Mine T, Takahashi S, Ashida K, Ishihara M, Masuyama T. Left atrial ejection force predicts the outcome after catheter ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2017; 29:264-271. [PMID: 29125704 DOI: 10.1111/jce.13387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/27/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Left atrium (LA) systolic dysfunction is observed in the early stages of atrial fibrillation (AF) prior to LA anatomical change. We investigated whether LA systolic dysfunction predicts recurrent AF after catheter ablation (CA) in patients with paroxysmal AF. METHODS AND RESULTS We studied 106 patients who underwent CA for paroxysmal AF. LA systolic function was assessed with the LA emptying volume = Maximum LA volume (LAVmax ) - Minimum LA volume (LAVmin ), LA emptying fraction = [(LAVmax - LAVmin )/LAVmax ] × 100, and LA ejection force calculated with Manning's method [LA ejection force = (0.5 × ρ × mitral valve area × A2 )], where ρ is the blood density and A is the late-diastolic mitral inflow velocity. Recurrent AF was detected in 35/106 (33%) during 14.6 ± 9.1 months. Univariate analysis revealed reduced LA ejection force, decreased LA emptying fraction, larger LA diameter, and elevated brain natriuretic peptide as significant variables. On multivariate analysis, reduced LA ejection force and larger LA diameter were independently associated with recurrent AF. Moreover, patients with reduced LA ejection force and larger LA diameter had a higher risk of recurrent AF than preserved LA ejection force (log-rank P = 0.0004). CONCLUSIONS Reduced LA ejection force and larger LA diameter were associated with poor outcome after CA for paroxysmal AF, and could be a new index to predict recurrent AF.
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Affiliation(s)
- Hideyuki Kishima
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takanao Mine
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoshi Takahashi
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kenki Ashida
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaharu Ishihara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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15
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Çimen T, Sunman H, Efe TH, Akyel A, Yayla K, Şahan HF, Bilgin M, Asarcıklı LD, Nallbani A, Doğan M, Açıkel S, Yeter E. Early changes in atrial conduction times in hypertensive patients with elevated pulse pressure. Rev Port Cardiol 2017; 36:453-459. [DOI: 10.1016/j.repc.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/09/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022] Open
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16
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Early changes in atrial conduction times in hypertensive patients with elevated pulse pressure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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Markowitz SM. Left Atrial Hypertension in Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:470-472. [DOI: 10.1016/j.jacep.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
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18
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Resting and Exercise-Induced Left Atrial Hypertension in Patients With Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:461-469. [DOI: 10.1016/j.jacep.2016.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/30/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022]
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19
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Njoku A, Kannabhiran M, Arora R, Reddy P, Gopinathannair R, Lakkireddy D, Dominic P. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace 2017; 20:33-42. [DOI: 10.1093/europace/eux013] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/21/2017] [Indexed: 11/13/2022] Open
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20
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KISHIMA HIDEYUKI, MINE TAKANAO, TAKAHASHI SATOSHI, ASHIDA KENKI, ISHIHARA MASAHARU, MASUYAMA TOHRU. The Impact of Elevated Left Atrial Pressure in Sinus Rhythm After Cardioversion on Outcomes After Catheter Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:813-9. [DOI: 10.1111/jce.12993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- HIDEYUKI KISHIMA
- Cardiovascular Division, Department of Internal Medicine; Hyogo College of Medicine; Nishinomiya Japan
| | - TAKANAO MINE
- Cardiovascular Division, Department of Internal Medicine; Hyogo College of Medicine; Nishinomiya Japan
| | - SATOSHI TAKAHASHI
- Cardiovascular Division, Department of Internal Medicine; Hyogo College of Medicine; Nishinomiya Japan
| | - KENKI ASHIDA
- Cardiovascular Division, Department of Internal Medicine; Hyogo College of Medicine; Nishinomiya Japan
| | - MASAHARU ISHIHARA
- Cardiovascular Division, Department of Internal Medicine; Hyogo College of Medicine; Nishinomiya Japan
| | - TOHRU MASUYAMA
- Cardiovascular Division, Department of Internal Medicine; Hyogo College of Medicine; Nishinomiya Japan
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21
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Evranos B, Kocyigit D, Gurses KM, Yalcin MU, Sahiner ML, Kaya EB, Ozer N, Aytemir K. Increased left atrial pressure predicts recurrence following successful cryoablation for atrial fibrillation with second-generation cryoballoon. J Interv Card Electrophysiol 2016; 46:145-51. [DOI: 10.1007/s10840-016-0107-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/18/2016] [Indexed: 11/27/2022]
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22
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Wu JT, Long DY, Dong JZ, Wang SL, Fan XW, Yang HT, Duan HY, Yan LJ, Qian P, Yang CK. Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation. J Cardiol 2015; 68:352-6. [PMID: 26611936 DOI: 10.1016/j.jjcc.2015.10.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/15/2015] [Accepted: 10/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been demonstrated that advanced interatrial block (IAB) is associated with an increased risk of atrial fibrillation (AF); however, the impact of advanced IAB on recurrence of paroxysmal AF after catheter ablation is not clear. METHODS 204 consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. In all patients, a resting electrocardiogram in sinus rhythm was evaluated for the presence of advanced IAB, defined as a P-wave duration >120ms and biphasic (±) morphology in the inferior leads. Advanced IAB was detected in 20.1% of patients. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30s beyond 3 months after the catheter ablation in the absence of any antiarrhythmic treatment. RESULTS During the mean follow-up period of 13.9±6.2 months (range, 3-27 months), 62 patients (30.4%) developed recurrence of AF. The recurrence rate was higher in patients with advanced IAB than those without advanced IAB (46.3% vs. 26.4%, p=0.006). Cox regression analysis with adjustment for age, P-wave duration, CHADS2 score, and PV isolation identified advanced IAB (hazard ratio, 2.111; 95% confidence interval, 1.034-4.308; p=0.040) and left atrial diameter (hazard ratio, 1.051; 95% confidence interval, 1.004-1.100; p=0.034) as two independent predictors of recurrence of AF. CONCLUSIONS Patients with advanced IAB were at an increased risk of AF recurrence after catheter ablation.
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Affiliation(s)
- Jin-Tao Wu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - De-Yong Long
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shan-Ling Wang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Xian-Wei Fan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hai-Tao Yang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hong-Yan Duan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Li-Jie Yan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Peng Qian
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao-Kuan Yang
- Department of Cardiology, Henan Medical College, Zhengzhou, China.
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Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation. Int J Cardiol 2015; 184:56-61. [DOI: 10.1016/j.ijcard.2015.01.060] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/30/2014] [Accepted: 01/25/2015] [Indexed: 11/17/2022]
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24
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Bergau L, Vollmann D, Luthje L, Sohns JM, Seegers J, Sohns C, Zabel M. Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation. Indian Pacing Electrophysiol J 2014; 14:181-93. [PMID: 25057219 PMCID: PMC4100084 DOI: 10.1016/s0972-6292(16)30774-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background It is suggested that an elevated left atrial pressure (LAP) promotes ectopic beats emanating in the pulmonary veins (PVs) and that LAP might be a marker for structural remodeling. This study aimed to identify if the quantification of LAP correlates with structural changes of the LA and may therefore be associated with outcomes following pulmonary vein isolation (PVI). Methods We analysed data from 120 patients, referred to PVI due to drug-refractory atrial fibrillation (AF) (age 63±8; 57% men). The maximum (mLAP) and mean LAP (meLAP) were measured after transseptal puncture. Results and Conclusions Within a mean follow-up of 303±95 days, 60% of the patients maintained in sinus rhythm after the initial procedure and 78% after repeated PVI. Performing univariate Cox-regression analysis, type of AF, LA-volume (LAV), mLAP and the meLAP were significant predictors of recurrence after PVI (p=0.03; p=0.001; p=0.01). In multivariate analysis mLAP>18mmHg, LAV>100 ml and the presence of persistent AF were significant predictors (p=0.001; p=0.019; p=0.017). The mLAP >18 mmHg was associated with a hazard ratio of 3.8. Analyzing receiver-operator characteristics, the area under the curve for mLAP was 0.75 (p<0.01). mLAP >18 mmHg predicts recurrence with a sensitivity of 77 % and specificity of 60 %. There was a linear correlation between the LAV from MDCT and mLAP (p = 0.01, R2 = 0.61). The mLAP measured invasively displays a significant predictor for AF recurrence after PVI. There is a good correlation between LAP and LAV and both factors may be useful to quantify LA remodeling.
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Affiliation(s)
- Leonard Bergau
- Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany
| | - Dirk Vollmann
- Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany
| | - Lars Luthje
- Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany
| | - Jan Martin Sohns
- Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany
| | - Joachim Seegers
- Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany
| | - Christian Sohns
- Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany
| | - Markus Zabel
- Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany
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Hirai T, Cotseones G, Makki N, Agrawal A, Wilber DJ, Barron JT. Usefulness of left ventricular diastolic function to predict recurrence of atrial fibrillation in patients with preserved left ventricular systolic function. Am J Cardiol 2014; 114:65-9. [PMID: 24819904 DOI: 10.1016/j.amjcard.2014.03.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
Abstract
It is unknown whether recurrence of atrial fibrillation (AF) is related to severity of left ventricular diastolic dysfunction (LVDD) before ablation in patients with preserved left ventricular ejection fraction (LVEF). We tested the hypothesis that the presence and/or severity of LVDD before catheter ablation are related to AF recurrence during the 12-month follow-up period in patients with normal LVEF. We also aimed to determine what echocardiographic and Doppler indexes of LVDD before ablation are associated with recurrence of AF after ablation. We identified 198 patients with normal LVEF who underwent catheter ablation for AF with evidence of normal sinus rhythm within 1 year before ablation. The recurrence rate during 12-month follow-up period was assessed. Of the 198 patients, 76 patients (38%) had symptomatic recurrence and 122 patients (62%) had no recurrence. None of the independent variables, including mitral valve Doppler E and A peak velocities, E/A ratio, tissue Doppler e' and a' peak velocities, left atrial volume index, isovolumic relaxation time, and deceleration time, predicted recurrence. Patients with average E/e' ratio >13, however, had increased recurrence (67% vs 35%, odds ratio 3.70, 95% confidence interval 1.21 to 11.3, p <0.05). In conclusion, there was no difference in the severity of LVDD using conventional echocardiographic indexes of LVDD in patients with or without recurrence of AF ablation. However, patients with average E/e' ratio >13 did have an increased recurrence rate of AF at 12 months after procedure. Therefore, E/e' ratio, indicative of increased left atrial pressure, may serve as a marker for AF recurrence after ablation.
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Characterization of Ventricular Myocardium in Atrial Fibrillation: Looking Where the Light Is Best. JACC Cardiovasc Imaging 2014; 7:12-3. [DOI: 10.1016/j.jcmg.2013.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 11/20/2022]
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Naji F, Pagliaruzzi M, Penko M, Kanic V, Vokac D. Changes in left ventricular filling in patients with persistent atrial fibrillation. Int J Med Sci 2013; 10:1876-9. [PMID: 24324364 PMCID: PMC3856378 DOI: 10.7150/ijms.6613] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 09/04/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Former studies showed possible interrelationship between altered ventricular filling patterns and atrial fibrillation (AF). HYPOTHESIS Long term persistent AF has a negative impact on left ventricular filling in patients with preserved ejection fraction of left ventricle. METHODS Our study was designed as a prospective case control study. We included 40 patients with persistent AF and preserved ejection fraction after successful electrical cardioversion and 43 control patients. Persistent AF was defined as AF lasting more than 4 weeks. Cardiac ultrasound was performed in all patients 24 hours after the procedure. Appropriate mitral flow and tissue Doppler velocities as well as standard echocardiographic measurements were obtained. RESULTS There were no significant differences between both groups' parameters regarding age, sex, commorbidities or drug therapy. Analysis of mitral flow velocities showed significant increase of E value in AF group (0.96±0.27 vs.0.70±0.14; p = 0.001). Tissue Doppler measurements didn't reveal any differences in early diastolic movement, however there was a statistically significant difference in E/Em values of both groups, respectively (12.0±4.0 vs. 9.0±2.1; p= 0.001). CONCLUSION Our study shows that in patients with preserved systolic function and persistent AF shortly after cardioversion diastolic ventricular filling patterns are altered mainly due to increased left atrial pressure and not due to impaired diastolic relaxation of left ventricle. Further studies are needed in order to define the interplay between diminished atrial function and impaired ventricular filling.
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Affiliation(s)
- Franjo Naji
- Department of Cardiology and Angiology, University Clinical Centre, Maribor, Slovenia
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