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Balik M, Waldauf P, Maly M, Brozek T, Rulisek J, Porizka M, Sachl R, Otahal M, Brestovansky P, Svobodova E, Flaksa M, Stach Z, Horejsek J, Volny L, Jurisinova I, Novotny A, Trachta P, Kunstyr J, Kopecky P, Tencer T, Pazout J, Krajcova A, Duska F. Echocardiography predictors of sustained sinus rhythm after cardioversion of supraventricular arrhythmia in patients with septic shock. J Crit Care 2024; 83:154832. [PMID: 38759581 DOI: 10.1016/j.jcrc.2024.154832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The echocardiography parameters may predict the maintenance of sinus rhythm after cardioversion of a supraventricular arrhythmia (SVA). MATERIALS AND METHODS Patients in septic shock with onset of an SVA, normal to moderately reduced LV systolic function (EF_LV˃̳35%) and on a continuous noradrenaline of <1.0 μg/kg.min were included. Echocardiography was performed at the arrhythmia onset, 1 h and 4 h post cardioversion on an infusion of propafenone or amiodarone. RESULTS Cardioversion was achieved in 96% of the 209 patients within a median time of 6(1.8-15.6)h, 134(64.1%) patients experienced at least one SVA recurrence after cardioversion. At 4 h the left atrial emptying fraction (LA_EF, cut-off 38.4%, AUC 0.69,p˂0.001), and transmitral A wave velocity-time-integral (Avti, cut-off 6.8 cm, AUC 0.65,p = 0.001) showed as limited predictors of a single arrhythmia recurrence. The LA_EF 44(36,49)%, (p = 0.005) and the Avti 8.65(7.13,9.50)cm, (p < 0.001) were associated with sustained sinus rhythm and decreased proportionally to increasing numbers of arrhythmia recurrences (p < 0.001 and p = 0.007, respectively). The enlarged left atrial end-systolic diameter at the arrhythmia onset (p = 0.04) and elevated systolic pulmonary artery pressure at 4 h (p = 0.007) were weak predictors of multiple(˃3) recurrences. CONCLUSION The LA_EF and Avti are related to arrhythmia recurrences post-cardioversion suggesting potential guidance to the choice between rhythm and rate control strategies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017.
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Affiliation(s)
- M Balik
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia.
| | - P Waldauf
- Department of Anaesthesiology and Intensive Care, 3(rd) Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Czechia
| | - M Maly
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - T Brozek
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - J Rulisek
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - M Porizka
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - R Sachl
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - M Otahal
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - P Brestovansky
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - E Svobodova
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - M Flaksa
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - Z Stach
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - J Horejsek
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - L Volny
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - I Jurisinova
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - A Novotny
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - P Trachta
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - J Kunstyr
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - P Kopecky
- Department of Anaesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czechia
| | - T Tencer
- Department of Anaesthesiology and Intensive Care, 3(rd) Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Czechia
| | - J Pazout
- Department of Anaesthesiology and Intensive Care, 3(rd) Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Czechia
| | - A Krajcova
- Department of Anaesthesiology and Intensive Care, 3(rd) Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Czechia
| | - F Duska
- Department of Anaesthesiology and Intensive Care, 3(rd) Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital in Prague, Czechia
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Raniga D, Goda M, Hattingh L, Thorning S, Rowe M, Howes L. Left atrial volume index: A predictor of atrial fibrillation recurrence following direct current cardioversion - A systematic review and meta-analysis. IJC HEART & VASCULATURE 2024; 51:101364. [PMID: 38426114 PMCID: PMC10902144 DOI: 10.1016/j.ijcha.2024.101364] [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: 11/26/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
This systematic review and meta-analysis was conducted to determine the clinical relevance of echocardiographically measured left atrial (LA) size to predict the recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV). A search was performed on Medline (Ovid), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL) in Cochrane Library, Wiley and Web of Science (Clarivate) to identify relevant studies. Amongst the initial 4066 citations identified, 31 fulfilled the criteria for inclusion in the data analysis incorporating 2725 patients with a mean follow-up period of 6.5 months. The weighted mean left atrial volume index (LAVI) was 40.56 ml/m2 (95 %CI:37.24-43.88) in the sinus rhythm (SR) maintenance group versus 48.69 ml/m2 (95 % CI: 44.42-52.97) in the AF recurrence group with P value of < 0.001, left atrial diameter (LAD) was 42.06 mm (95 %CI: 41.08-43.05) in the SR maintenance group versus 45.13 mm (95 %CI: 44.09-46.16) in the AF recurrence group, P value < 0.001. Effect size analysis of LAVI showed that each unit increase in LAVI resulted in an increase in the risk of AF recurrence by 6 % (95 % CI: 3 %-10 %). Age and AF duration were also statistically significant between the two groups however comorbidities, use of beta blockers or amiodarone were not significantly different. This meta-analysis shows that AF duration, LAVI, LAD and age predict the risk of recurrence of atrial fibrillation post electrical cardioversion with LAVI being the most clinically relevant echocardiographic feature.
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Affiliation(s)
- Dipesh Raniga
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Mina Goda
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Laetitia Hattingh
- Allied Health Research, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
- School of Pharmacy, The University of Queensland, QLD 4102, Australia
- School of Pharmacy and Medical Sciences, Griffith University, QLD 4222, Australia
| | - Sarah Thorning
- Office of Research, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Matthew Rowe
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
| | - Laurie Howes
- Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia
- School of Medicine, Griffith University, QLD 4222, Australia
- School of Medicine, Bond University, QLD 4226, Australia
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3
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Ligero C, Bazan V, Guerra JM, Rodríguez-Mañero M, Viñolas X, Alegret JM. Influence of body mass index on recurrence of atrial fibrillation after electrical cardioversion. PLoS One 2023; 18:e0291938. [PMID: 37738256 PMCID: PMC10516430 DOI: 10.1371/journal.pone.0291938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Several studies have shown an independent relationship between body mass index (BMI) and the incidence of atrial fibrillation (AF). However, little is known about the influence of BMI on AF recurrence after electrical cardioversion (ECV). METHODS We selected 1121 patients who reverted to sinus rhythm after scheduled ECV and were included in three prospective Spanish registries of ECV in persistent AF. The patients were classified according to baseline BMI into three categories (normal weight, overweight, obesity). We assessed the influence of BMI on the rate of AF recurrence at 3 months. RESULTS We identified 538 patients (48%) who had AF recurrence in the first 3 months after successful ECV. The patients who suffered AF recurrence had a higher BMI than those who remained in sinus rhythm (29.66±4.57 vs. 28.87±4.64 Kg/m2, respectively; p = 0.004). We observed a higher incidence of AF recurrence in the overweight and obese patients (BMI ≥25 kg/m2) than in those classified as normal weight (50.5% vs. 35.6%, respectively; p<0,001). BMI≥25 Kg/m2 was shown to be independently related to of AF recurrence in the multivariate analysis (OR = 1.75, 95% confidence interval = 1.20-2.58; p = 0.004). CONCLUSIONS Increased BMI is independently related to AF recurrence after ECV. BMI should also be taken into account when making decisions about the indication for ECV in persistent AF.
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Affiliation(s)
- Carmen Ligero
- Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Spain
| | - Victor Bazan
- Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - José M. Guerra
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Moisés Rodríguez-Mañero
- Hospital Clínico Universitario de Santiago, Universidad de Santiago, Santiago de Compostela, Spain
| | - Xavier Viñolas
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M. Alegret
- Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Spain
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Wałek P, Roskal-Wałek J, Dłubis P, Wożakowska-Kapłon B. Echocardiographic Evaluation of Atrial Remodelling for the Prognosis of Maintaining Sinus Rhythm after Electrical Cardioversion in Patients with Atrial Fibrillation. J Clin Med 2023; 12:5158. [PMID: 37568560 PMCID: PMC10419596 DOI: 10.3390/jcm12155158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Atrial fibrillation (AF) is the most common atrial tachyarrhythmia. One of the methods of AF treatment is direct current cardioversion (DCCV), but in the long-term follow-up we observe quite a high percentage of AF recurrences after this procedure. In order to assess the prognosis of DCCV effectiveness, we use clinical, biochemical and echocardiographic parameters. The objective of this review is to systematise the current knowledge on echocardiographic measurements in patients with persistent AF used to assess the progress of remodelling of the atrial wall, which affects the likelihood of maintaining sinus rhythm after DCCV. In this article, echocardiographic parameters for the evaluation of remodelling of the atrial wall are divided into groups referring to structural, mechanical, and electrical remodelling, as well as parameters for the evaluation of left ventricular filling pressure. The article aims to draw attention to the clinical value of echocardiographic measurements, which is the selection of patients who will maintain sinus rhythm after DCCV in the long-term follow-up, which will allow to avoid unnecessary risks associated with the procedure and enable the selection of the appropriate treatment strategy.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | - Patryk Dłubis
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Park JK. Is Right Atrial Remodeling an Additional Marker for the Progression of Atrial Fibrillation? Korean Circ J 2023; 53:344-346. [PMID: 37161748 PMCID: PMC10172269 DOI: 10.4070/kcj.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/11/2023] Open
Affiliation(s)
- Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea.
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6
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Wałek P, Roskal-Wałek J, Dłubis P, Tracz J, Wożakowska-Kapłon B. Left Atrial Wall Motion Velocity Assessed during Atrial Fibrillation Predicts Sinus Rhythm Maintenance after Electrical Cardioversion in Patients with Persistent Atrial Fibrillation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15508. [PMID: 36497585 PMCID: PMC9740887 DOI: 10.3390/ijerph192315508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Reduced left atrial wall motion velocity measured during AF (LAWMV) indicates left atrial remodeling. The aim of this study was to investigate whether LAWMV assessed with tissue Doppler imaging during atrial fibrillation (AF) predicts sinus rhythm (SR) maintenance after direct current cardioversion (DCCV) for persistent AF. The study included 126 patients who underwent DCCV and were followed for 12 months. At 12 months, maintained SR was reported in 55 patients (43.7%). We noted that LAWMV was higher in patients with maintained SR at 12 months than in those with recurrent AF (3.69 ± 0.84 vs. 2.86 ± 1.09; p < 0.001). In the multivariable regression model containing echocardiographic variables, LAWMV was an independent predictor of SR maintenance at 12 months (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.1-2.69; p = 0.017). Similarly, LAWMW was an independent predictor of SR maintenance at 12 months (OR 1.81, 95% CI 1.19-2.77; p = 0.006) in the multivariate regression model containing both echocardiographic and clinical variables. LAWMV predicts SR maintenance after DCCV for persistent AF. Echocardiographic markers of left atrial mechanical remodeling are better at predicting SR maintenance than markers of structural remodeling.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | - Patryk Dłubis
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| | - Justyna Tracz
- Clinic of Neurology, Swietokrzyskie Neurology Center, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Tore D, Faletti R, Biondo A, Carisio A, Giorgino F, Landolfi I, Rocco K, Salto S, Santonocito A, Ullo F, Anselmino M, Fonio P, Gatti M. Role of Cardiovascular Magnetic Resonance in the Management of Atrial Fibrillation: A Review. J Imaging 2022; 8:300. [PMID: 36354873 PMCID: PMC9696856 DOI: 10.3390/jimaging8110300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 08/30/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is growing with time. Since the introduction of catheter ablation procedures for the treatment of AF, cardiovascular magnetic resonance (CMR) has had an increasingly important role for the treatment of this pathology both in clinical practice and as a research tool to provide insight into the arrhythmic substrate. The most common applications of CMR for AF catheter ablation are the angiographic study of the pulmonary veins, the sizing of the left atrium (LA), and the evaluation of the left atrial appendage (LAA) for stroke risk assessment. Moreover, CMR may provide useful information about esophageal anatomical relationship to LA to prevent thermal injuries during ablation procedures. The use of late gadolinium enhancement (LGE) imaging allows to evaluate the burden of atrial fibrosis before the ablation procedure and to assess procedural induced scarring. Recently, the possibility to assess atrial function, strain, and the burden of cardiac adipose tissue with CMR has provided more elements for risk stratification and clinical decision making in the setting of catheter ablation planning of AF. The purpose of this review is to provide a comprehensive overview of the potential applications of CMR in the workup of ablation procedures for atrial fibrillation.
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Affiliation(s)
- Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Andrea Biondo
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Andrea Carisio
- Department of Radiology, Humanitas Gradenigo Hospital, 10126 Turin, Italy
| | - Fabio Giorgino
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Ilenia Landolfi
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Katia Rocco
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Sara Salto
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Ambra Santonocito
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Federica Ullo
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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Chen Q, Chen Y, Qin F, Du H, Gan C, Zhou B, Wang N, Xiao M, Ou Z, Zhao W, Cui B, Liu Z, Yin Y. Effect of Sacubitril-Valsartan on Restoration and Maintenance of Sinus Rhythm in Patients With Persistent Atrial Fibrillation. Front Cardiovasc Med 2022; 9:870203. [PMID: 35707128 PMCID: PMC9189349 DOI: 10.3389/fcvm.2022.870203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
Background Existing studies have shown that sacubitril-valsartan ameliorated atrial remodeling in atrial fibrillation (AF) and favored maintenance of sinus rhythm in patients with AF and heart failure. However, the effect of sacubitril-valsartan in patients with persistent AF is yet unknown. We aimed to evaluate the effect of sacubitril-valsartan on restoration and maintenance of sinus rhythm in patients with persistent AF who underwent electrical cardioversion (ECV). Method Consecutive patients with persistent AF who underwent ECV between 1 January 2016 and 30 September 2020 were investigated in this retrospective cohort study. All eligible patients were categorized into sacubitril-valsartan users and sacubitril-valsartan non-users based on whether they received treatment with sacubitril-valsartan or not. The endpoint was ineffictive ECV, defined as the composite of failure to terminate AF or any recurrence of AF during 30 days follow-up. Results A total of 76 patients were enrolled in this study, including 28 sacubitril-valsartan users and 48 non-users. Within a follow-up of 30 days after ECV, the endpoint had occurred in 7 (25%) of 28 sacubitril-valsartan users and 25 (52%) of 48 non-users. Significantly lower rate of ineffictive ECV in sacubitril-valsartan users compared with non-users was shown in Kaplan-Meier survival curves (P = 0.02; Log-rank test). Multivariate Cox regression analysis indicated that sacubitril-valsartan use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14–0.91), amiodarone use (HR, 0.32; 95% CI, 0.13–0.78), left atrial diameter ≤ 39 mm (HR, 0.21; 95% CI, 0.06–0.71) were independently associated with a decreased rate of ineffective electrical cardioversion. Conclusion Use of sacubitril-valsartan is associated with a significantly decreased risk of ineffective ECV compared with non-users in patients with persistent AF.
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9
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(Echocardiographic assessment of left atrial remodeling as a predictor for the nonvalvular atrial fibrillation recurrence). COR ET VASA 2021. [DOI: 10.33678/cor.2021.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Malavasi VL, Fantecchi E, Tordoni V, Melara L, Barbieri A, Vitolo M, Lip GYH, Boriani G. Atrial fibrillation pattern and factors affecting the progression to permanent atrial fibrillation. Intern Emerg Med 2021; 16:1131-1140. [PMID: 33161524 DOI: 10.1007/s11739-020-02551-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) may progress from a non-permanent to a permanent form, and improvement in prediction may help in decision-making. In- and outpatients with non-permanent AF were enrolled in a prospective study and followed every 6 months. At baseline, 314 out of 523 patients (60%) had non-permanent AF (25.5% paroxysmal AF, 52.5% persistent, 2% first diagnosed AF). They were mostly males (188, 59.9%), median age 71 years [interquartile range (IQ) 62-77], median CHA2DS2VASc 3 (IQ 1-4), median HATCH score 1 (IQ 1-2). During a follow-up of 701 (IQ 437-902) days, 66 patients (21%) developed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated with AF progression (p for trend CHA2DS2VASc < 0.001, HATCH p = 0.001). Cox multivariable proportional hazard regression analysis showed that age [hazard ratio (HR) 1.042; 95%CI 1.005-1.080; p = 0.025], moderate-severe left atrial (LA) enlargement at echo (HR 2.072, 95%CI, 1.121-3.831; p = 0.020), antiarrhythmics drugs (HR 0.087, 95%CI 0.011-0.659, p = 0.018), EHRA score > 2 (HR 0.358, 95%CI 0.162-0.791, p = 0.011) and valvular disease (HR 2.196, 95%CI 1.072-4.499, p = 0.032) were significantly associated with AF progression. Adding "moderate-severe LA dilation" to clinical scores, eg. HATCH score (HATCH-LA) with 2 points (Cox multivariable regression analysis) improved prediction of AF progression vs. HATCH score (p = 0.0225). In patients without permanent AF, progression of AF was independently associated with age, LA dilation, AF symptoms severity, antiarrhythmic drugs and valvular disease. Adding LA dilation (moderate-severe volume increase) to clinical scores improved prediction of progression to permanent AF.
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Affiliation(s)
- Vincenzo Livio Malavasi
- Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy
| | - Elisa Fantecchi
- Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy
| | - Virginia Tordoni
- Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy
| | - Laura Melara
- Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy
| | - Andrea Barbieri
- Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy.
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11
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Choi JH, Kwon HJ, Kim HR, Park SJ, Kim JS, On YK, Park KM. Electrocardiographic predictors of early recurrence of atrial fibrillation. Ann Noninvasive Electrocardiol 2021; 26:e12884. [PMID: 34333816 PMCID: PMC8588373 DOI: 10.1111/anec.12884] [Citation(s) in RCA: 2] [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: 05/21/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Electrical cardioversion (ECV) is an effective method for restoring sinus rhythm after atrial fibrillation (AF). However, early recurrence of AF occurs in a significant number of patients after ECV. This study aimed to identify electrocardiographic (ECG) predictors of early AF recurrence after ECV. METHODS A total of 272 patients with persistent AF undergoing successful ECV were consecutively enrolled in this study. We investigated clinical, echocardiographic, and ECG data. The 12-lead ECG parameters were measured during sinus rhythm right after ECV using a digital caliper. The early AF recurrence was defined as recurrence within 2 months. RESULTS Of the 272 patients, 165 patients (60.7%) experienced an early AF recurrence. Maximum P-wave duration (PWD) in limb leads (OR: 1.086; 95% CI: 1.019-1.157; p = .012) and P-terminal force (PTF) in V1 (OR: 1.019; 95% CI: 1.004-1.033; p = .011) were independent predictors of early AF recurrence after ECV. The optimal cutoff value of the maximum PWD in limb leads for predicting early AF recurrence was 134 ms, characterized by 90.3% sensitivity and 72.0% specificity. Likewise, the optimal cutoff value of PTF in V1 was 50 ms × mm, characterized by 80.0% sensitivity and 64.5% specificity. CONCLUSION A longer PWD (>134 ms) and a larger PTF (>50 ms × mm) were useful predictors of early recurrence of AF after successful ECV in clinical practice. A more effective rhythm control therapy such as catheter ablation or rate control strategy rather than a repeat ECV should be considered.
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Affiliation(s)
- Ji-Hoon Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee-Jin Kwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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12
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Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study. J Hypertens 2021; 38:1140-1148. [PMID: 32371804 DOI: 10.1097/hjh.0000000000002367] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Increased arterial stiffness is currently recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort. METHODS We included 1156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by cardio-ankle vascular index (CAVI). Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit, and pump strain as well as left ventricular global longitudinal strain (LVGLS). RESULTS CAVI was negatively correlated with reservoir and conduit strain (r = -0.37 and -0.45, both P < 0.001), whereas weakly, but positively correlated with LA volume index and pump strain (r = 0.12 and 0.09, both P < 0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors and LV morphology and function including LVGLS (standardized β = -0.22 and -0.27, respectively, both P < 0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir and conduit strain (adjusted odds ratio = 2.61 and 3.73 vs. normal CAVI, both P < 0.01) in a fully adjusted model including laboratory and echocardiographic parameters. CONCLUSION Arterial stiffness was independently associated with LA phasic function, even in the absence of overt cardiovascular disease, which may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.
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Wałek P, Ciesla E, Gorczyca I, Wożakowska-Kapłon B. Left atrial wall dyskinesia assessed during contractile phase as a predictor of atrial fibrillation recurrence after electrical cardioversion performed due to persistent atrial fibrillation. Medicine (Baltimore) 2020; 99:e23333. [PMID: 33285712 PMCID: PMC7717756 DOI: 10.1097/md.0000000000023333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Direct current cardioversion (DCCV) is one of the basic methods for restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). Left atrial (LA) strain is one of the parameters used to assess the risk of AF recurrence following DCCV. Assessing the strain also allows for the detection of segmental disorders of LA wall contractility, including dispersion or dyskinesia. In the present study, we determined the predictive value of LA wall dyskinesia in assessing the risk of AF recurrence after DCCV. We performed a comprehensive echocardiography in 89 patients with persistent AF following successful DCCV. We assessed the strain and strain rate in the reservoir (r), conduit, and contractile (ct) phases by using speckle tracking echocardiography. Dyskinesia was diagnosed when the strain rate of any segment of the LA wall displayed positive values during contraction. After 12 months, 47.2% of patients maintained SR. Patients who maintained SR had a significantly lower LA strain (LAS)r assessed in the apical 4-chamber view (4c) (11.38 ± 4.63 vs 14.54 ± 5.11; P = .004) and 2-chamber view (2c) (11.05 ± 4.1 vs 14.93 ± 6.82%; P = .006), LASct4c (2.51 ± 2.3 vs 5.09 ± 3.29%; P < .001), LASct2c (3.6 ± 2.98 vs 5.67 ± 4.23%; P = .008), peak strain rate (pLASR) ct4c (0.36 ± 0.24 s vs 0.62 ± 0.4; P < .001) and pLASRct2c (0.49 ± 0.30 vs 0.79 ± 0.53 s; P = .01). LA dyskinesia was observed less frequently in the 4c view in patients who maintained SR (59.57 vs 17.5%; P < .001). Multivariable logistic regression showed that the LASct4c (odds ratio (OR) 0.78; 95%CI 0.63-0.97; P = .027) and LA dyskinesia observed in the 4c view (OR 3.53; 95%CI 1.16-10.76; P = .027) were significant independent predictors of AF recurrence at 12 months. We conclude that LA dyskinesia observed in the 4c view and LASct4c are independent risk factors for AF recurrence following DCCV.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Elzbieta Ciesla
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
| | - Iwona Gorczyca
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
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Eren H, Kaya Ü, Öcal L, Şenbaş A, Kalçık M. The presence of fragmented QRS may predict the recurrence of nonvalvular atrial fibrillation after successful electrical cardioversion. Ann Noninvasive Electrocardiol 2020; 25:e12700. [PMID: 31502750 PMCID: PMC7358817 DOI: 10.1111/anec.12700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/31/2019] [Accepted: 08/12/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF), the most common cardiac rhythm disorder, affects approximately 2% of the general population and is associated with increased risk of stroke and mortality as well as reduced exercise capacity and quality of life. After restoring normal sinus rhythm, a portion of these patients develops recurrent AF despite optimal medical treatment. In this study, we aimed to assess the relationship between the presence of fragmented QRS (fQRS) and AF recurrence following successful electrical cardioversion (ECV). MATERIAL AND METHODS A total of 306 patients with nonvalvular persistent AF achieving restoration of the sinus rhythm after successful ECV were included in this study. After ECV, patients were monitored at least 6 months for recurrence. The patients were divided into two groups according to the presence of fQRS and compared for AF recurrence during follow-up. RESULTS Patients were followed up for a mean time of 220 ± 113 days. AF recurred in 119 patients, corresponding to a recurrence rate of 38.8%. AF recurrence was found to be significantly increased in patients with fQRS as compared to those without fQRS (76.4% vs. 23.5%, p < .001). Furthermore, the presence of fQRS was higher in patients with recurrent AF as compared to others (57.1% vs. 11.2%, p < .001). In multiple regression analyses, the presence of fQRS was one of the independent predictors of AF recurrence (hazard ratio: 9.670, 95% CI: 4.714-19.837, p < .001). CONCLUSION The presence of fQRS may be associated with the recurrence of AF after successful ECV in persistent nonvalvular AF patients.
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Affiliation(s)
- Hayati Eren
- Department of CardiologyElbistan State HospitalKahramanmaraşTurkey
| | - Ülker Kaya
- Department of CardiologyElbistan State HospitalKahramanmaraşTurkey
| | - Lütfi Öcal
- Department of CardiologyKosuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Ahmet Şenbaş
- Department of CardiologyElbistan State HospitalKahramanmaraşTurkey
| | - Macit Kalçık
- Department of CardiologyHitit UniversityFaculty of MedicineÇorumTurkey
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16
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Balik M, Waldauf P, Maly M, Matousek V, Brozek T, Rulisek J, Porizka M, Sachl R, Otahal M, Brestovansky P, Svobodova E, Flaksa M, Stach Z, Pazout J, Duska F, Smid O, Stritesky M. Efficacy and safety of 1C class antiarrhythmic agent (propafenone) for supraventricular arrhythmias in septic shock compared to amiodarone: protocol of a prospective randomised double-blind study. BMJ Open 2019; 9:e031678. [PMID: 31481571 PMCID: PMC6731952 DOI: 10.1136/bmjopen-2019-031678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Supraventricular arrhythmias contribute to haemodynamic compromise in septic shock. A retrospective study generated the hypothesis that propafenone could be more effective than amiodarone in achieving and maintaining sinus rhythm (SR). Certain echocardiographic parameters may predict a successful cardioversion and help in the decision on rhythm or rate control strategy. METHODS AND ANALYSIS The trial includes septic shock patients with new-onset arrhythmia, but without severe impairment of the left ventricular ejection fraction. After baseline echocardiography, the patient is randomised to receive a bolus and maintenance dose of either amiodarone or propafenone. The primary outcome is the proportion of patients that have achieved rhythm control at 24 hours after the start of the infusion. The secondary outcomes are the percentages of patients that needed rescue treatments (DC cardioversion or unblinding and crossover of the antiarrhythmics), the recurrence of arrhythmias, intensive care unit mortality, 28-day and 1-year mortality. In the posthoc analysis, we separately assess subgroups of patients with pulmonary hypertension and right ventricular dysfunction. In the exploratory part of the study, we assess whether the presence of a transmitral diastolic A wave and its higher velocity-time integral is predictive for the sustainability of mechanical SR and whether the indexed left atrial endsystolic volume is predictive of recurrent arrhythmia. Considering that the restoration of SR within 24 hours occurred in 74% of the amiodarone-treated patients and in 89% of the patients treated with propafenone, we plan to include 200 patients to have an 80% chance to demonstrate the superiority of propafenone at p=0.05. ETHICS AND DISSEMINATION The trial is recruiting patients according to its second protocol version approved by the University Hospital Ethical Board on the 6 October 2017 (No. 1691/16S-IV). The results will be disseminated through peer reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03029169.
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Affiliation(s)
- Martin Balik
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Petr Waldauf
- Anaesthesia and Intensive Care, 3rd Medical Faculty, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic, EU
| | - Michal Maly
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Vojtech Matousek
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Tomas Brozek
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Jan Rulisek
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Michal Porizka
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Robert Sachl
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Michal Otahal
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Petr Brestovansky
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Eva Svobodova
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Marek Flaksa
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Zdenek Stach
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
| | - Jaroslav Pazout
- Anaesthesia and Intensive Care, 3rd Medical Faculty, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic, EU
| | - Frantisek Duska
- Anaesthesia and Intensive Care, 3rd Medical Faculty, Charles University and Kralovske Vinohrady University Hospital in Prague, Prague, Czech Republic, EU
| | - Ondrej Smid
- 2nd Department of Medicine, 1st Medical Faculty, Charles University and General Univeristy Hospital in Prague, Prague, Czech Republic, EU
| | - Martin Stritesky
- Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic, EU
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17
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Moreno-Ruiz LA, Madrid-Miller A, Martínez-Flores JE, González-Hermosillo JA, Arenas-Fonseca J, Zamorano-Velázquez N, Mendoza-Pérez B. Left atrial longitudinal strain by speckle tracking as independent predictor of recurrence after electrical cardioversion in persistent and long standing persistent non-valvular atrial fibrillation. Int J Cardiovasc Imaging 2019; 35:1587-1596. [PMID: 30993507 PMCID: PMC6700045 DOI: 10.1007/s10554-019-01597-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/03/2019] [Indexed: 11/01/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in humans. After successful cardioversion, there is a recurrence of 60% due to atrial remodeling, and it has been shown that the global peak atrial longitudinal strain (GPALS) is decreased in these subjects. The aim of this study was to evaluate the predictive value of GPALS for AF recurrence. A prospective cohort of patients with persistent (PnVAF) and long standing persistent non-valvular AF (LSPnVAF) which underwent electrical cardioversion was evaluated with standard echocardiographic variables and GPALS quantification. The primary endpoint was AF recurrence at 6 months. We included PnVAF (n = 50, aged 68.4 ± 10.2 years, female 46%, lasted AF 6 months) and LSPnVAF (n = 81, aged 66.5 ± 13.1 years, female 36%, lasted AF 18 months). At 6 months there were a 68% of recurrence of AF in PnVAF and 53% in LSPnVAF group. GPALS was lower in recurrence 7.8 ± 2.0% versus 21.2 ± 8.9% (p < 0.001) for PnVAF and 7.3 ± 2.7% versus 20.7 ± 7.6% (p < 0.001) in LSPnVAF. GPALS ≤ 10.75% discriminates recurrence at 6 months with a sensitivity of 85%, specificity 99%, PPV 85%, NPV 90%, LR + 8.5 and LR- 0.17. The independent predictors of recurrence in PnVAF were GPALS ≤ 10.75% HR 8.89 [(2.2-35.7), p < 0.01] meanwhile in LSPnVAF were age HR 1.039 [(1.007-1.071), p = 0.01], and GPALS ≤ 10.75% HR 28.1 [(7.2-109.1), p < 0.001]. In subjects with PnVAF and LSPnVAF with successful electrical cardioversion, GPALS ≤ 10.75% predicts arrhythmia recurrence at 6-month follow-up.
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Affiliation(s)
- Luis Antonio Moreno-Ruiz
- Division of Cardiology, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico.
| | - Alejandra Madrid-Miller
- Direction of Education and Research, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Jerónimo Enrique Martínez-Flores
- Department of Electrophysiology, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Jesús Antonio González-Hermosillo
- Medical Subadrees of Innovation and Development Project, Instituto Nacional de Cardiología "Ignacio Chávez", 1 Juan Badiano, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Jorge Arenas-Fonseca
- Department of Echocardiography, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Noé Zamorano-Velázquez
- Department of Echocardiography, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Beatriz Mendoza-Pérez
- Division of Cardiology, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, 330 Cuauhtémoc Av, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
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Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion. ACTA ACUST UNITED AC 2019; 55:medicina55090511. [PMID: 31438560 PMCID: PMC6780583 DOI: 10.3390/medicina55090511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/04/2019] [Accepted: 08/19/2019] [Indexed: 01/29/2023]
Abstract
Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of stroke and thromboembolic complications. A rhythm control strategy with both electrical and pharmacological cardioversion is recommended for patients with symptomatic atrial fibrillation. Anticoagulant therapy for 3–4 weeks prior to cardioversion is recommended in order to avoid thromboembolic events deriving from restoring sinus rhythm. Transesophageal echocardiography has a pivotal role in this setting, excluding the presence of left atrial appendage thrombus before cardioversion. The aim of this review is to discuss the epidemiology and risk factors for left atrial appendage thrombosis, the role of echocardiography in the decision making before cardioversion, and the efficacy of different anticoagulant regimens on the detection and treatment of left atrial appendage thrombosis.
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Guarguagli S, Kempny A, Cazzoli I, Barracano R, Gatzoulis MA, Dimopoulos K, Ernst S. Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease. Europace 2019; 21:1334-1344. [DOI: 10.1093/europace/euz157] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/04/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Aims
Advances in surgical techniques allow an increasing number of children with congenital heart disease (CHD) to reach adulthood. As patients grow older, atrial fibrillation (AF) is evolving into a major clinical concern and can be difficult to manage medically. Primary AF catheter ablation may, therefore, have a role in this setting but few reports have evaluated its efficacy in CHD patients.
Methods and results
We retrospectively reviewed 58 consecutive patients [median age 51, interquartile range (IQR) 44–63 years, 57% male] with AF (45% paroxysmal) who underwent 122 ablation procedures in our tertiary centre in the last decade. The majority had CHD of moderate or severe complexity (57%, Bethesda Class 2 or 3) with a dilated left atrium (LA) (81%) and/or right atrium (86%). At 1-year from the first ablation, 32.8% of patients remained in sinus rhythm. Multiple procedures were required in 35 (60%) patients. Freedom from AF at 1-year after the 2nd and 3rd ablation was 40.9% and 36.5%, respectively. Multivariable predictors of AF recurrence were underlying anatomic complexity [hazard ratio (HR) in Bethesda 3 1.98, P = 0.006], type of AF (HR for persistent 1.87, P = 0.004), and indexed LA dimensions (HR for cm2/m2 1.06, P = 0.03).
Conclusion
While ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice.
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Affiliation(s)
- Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aleksander Kempny
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Rosaria Barracano
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
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Alzahrani T, McCaffrey J, Mercader M, Solomon A. Rate Versus Rhythm Control in Patients with Normal to Mild Left Atrial Enlargement: Insights from the AFFIRM Trial. J Atr Fibrillation 2019; 11:2067. [PMID: 31139272 DOI: 10.4022/jafib.2067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/19/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022]
Abstract
Background Atrial fibrillation is the most commonly encountered sustained arrhythmia and is associated with significant morbidity and mortality. Several trials have demonstrated that no mortality benefit exists when choosing a rhythm-control strategy over a rate-control strategy, with some trials suggesting an increase in mortality. Using the AFFIRM trial database we sought to determine the effect of rhythm control strategy in patients with normal or mild atrial enlargement. Methods AFFIRM Trial database was used to evaluate the effect of rhythm-control strategy compared to rate-control strategy in a subgroup of patients with normal to mild left atrial (LA) enlargement. The primary outcome measures of this study were all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, and hospitalization/ED visit. Results We identified a subgroup of subjects from the AFFIRM trial with normal or mild LA enlargement (n=2022 of 4060 total subjects). Subjects in the rhythm-control group(n= 1022) had an increased risk of all-cause mortality by 34% (RR 1.34, 95% CI 1.08-1.67; P=0.007) and hospitalization/ED visits by 10% (RR 1.10, 95% CI 1.05-2.16; P=<0.001) compared to rate control group(n= 1000). Conclusion This study demonstrated that rhythm-control strategy increases the risk of mortality and hospitalization in a subgroup of patients with normal to mild atrial enlargement compared to rate-control strategy. Amiodarone use in this subgroup of patients likely drove these findings.
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Affiliation(s)
- Talal Alzahrani
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
| | - James McCaffrey
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
| | - Marco Mercader
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
| | - Allen Solomon
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
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Karaliute R, Jureviciute J, Jurgaityte J, Stanaitiene G, Mizariene V, Kazakevicius T, Urboniene D, Kavoliuniene A. Relationship of Natriuretic Peptides with Left Atrial Structure and Function within 1 Month after Electrical Cardioversion in Patients with Persistent Atrial Fibrillation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7636195. [PMID: 31008112 PMCID: PMC6441525 DOI: 10.1155/2019/7636195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation (AF) despite the absence of heart failure is related to increased levels of natriuretic peptides (NPs). NPs have not been widely investigated in relation to left atrium (LA) function after sinus rhythm (SR) restoration and duration of AF. The aim of the study was to determine the changes of NPs levels and to define their relation with LA phasic function after electrical cardioversion (ECV). Methods. The study included 48 persistent AF patients with restored SR after ECV. NT-proANP and NT-proBNP were measured for all patients before the ECV. LA phasic function (reservoir, conduit, and pump phases) was assessed using echocardiographic volumetric analysis within the first 24 hours after ECV. Patients were repeatedly tested after 1 month in case of SR maintenance. Results. After 1 month, SR was maintained in 26 (54%) patients. For those patients, NT-proBNP decreased significantly (p=0.0001), whereas NT-proANP tended to decrease (p=0.13). Following 1 month after SR restoration, LA indexed volume decreased (p=0.0001) and all phases of LA function improved (p=<0.01). Patients with AF duration < 3 months had lower NT-proANP compared to patients with AF duration from 6 to 12 months (p = 0.005). Higher NT-proANP concentration before ECV was associated with lower LA reservoir function during the first day after SR restoration (R=-0.456, p=0.005), whereas higher NT-proBNP concentration after 1 month in SR was significantly related to lower LA reservoir function (R=-0.429, p=0.047). Conclusions. LA indexed volume, all phases of LA function, and NT-proBNP levels improved significantly following 1 month of SR restoration. Preliminary results suggest that higher baseline NT-proANP levels and higher NT-proBNP for patients with maintained SR for 1 month are related to lower LA reservoir function. The longer duration of persistent AF is associated with higher NT-proANP concentration.
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Affiliation(s)
- Rasa Karaliute
- Laboratory of Behavioral Medicine, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Justina Jureviciute
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Julija Jurgaityte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Giedre Stanaitiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Vaida Mizariene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Tomas Kazakevicius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Daiva Urboniene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Ausra Kavoliuniene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
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22
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Rosenberg JH, Werner JH, Plitt GD, Noble VV, Spring JT, Stephens BA, Siddique A, Merritt-Genore HL, Moulton MJ, Agrawal DK. Immunopathogenesis and biomarkers of recurrent atrial fibrillation following ablation therapy in patients with preexisting atrial fibrillation. Expert Rev Cardiovasc Ther 2019; 17:193-207. [PMID: 30580643 PMCID: PMC6386629 DOI: 10.1080/14779072.2019.1562902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/20/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recurrent atrial fibrillation (RAF) following ablation therapy occurs in about 50% of patients. The pathogenesis of RAF is unknown, but is believed to be driven by atrial remodeling in the setting of background inflammation. Structural, electrophysiological and mechanical remodeling has been associated with atrial fibrillation (AF). Inflammation and fibrotic remodeling are the major factors perpetuating AF, as mediators released from the atrial tissues and cardiomyocytes due to mechanical and surgical injury could initiate the inflammatory process. In this article, we have critically reviewed the key mediators that may serve as potential biomarkers to predict RAF. Areas covered: Damage associated molecular patterns, heat shock proteins, inflammatory cytokines, non-inflammatory markers, markers of inflammatory cell activity, and markers of collagen deposition and metabolism are evaluated as potential biomarkers with molecular treatment options in RAF. Expert commentary: Establishing biomarkers to predict RAF could be useful in reducing morbidity and mortality. Investigations into the role of DAMPs participating in a sterile immune response may provide greater insight into the pathogenesis of RAF. Markers evaluating immune cell activity, collagen deposition, and levels of heat shock proteins show the greatest promise as potential biomarkers to predict RAF and develop novel therapies.
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Affiliation(s)
- John H Rosenberg
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - John H Werner
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Gilman D Plitt
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Victoria V Noble
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Jordan T Spring
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Brooke A Stephens
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Aleem Siddique
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | | | - Michael J Moulton
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
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23
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Inflammatory and Imaging-based Predictors of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation Using Electroanatomical Mapping – the INFLAMAP Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2018. [DOI: 10.2478/jim-2018-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
Atrial fibrillation (AF) is the most frequent form of supraventricular arrhythmia in medical practice. It is characterized by chaotic electrical activity in the atria, which often leads to irregular and fast ventricular contractions. Pulmonary veins (PV) play an essential part in the genesis of AF. There are a series of risk factors that trigger the development and recurrence of AF after PV isolation. Despite advanced medical technology, the success rate of AF ablation is not satisfactory. The purpose of this study is to assess the preprocedural imaging and serum biomarkers linked to an increased recurrence of AF after PV isolation. The primary endpoint is represented by AF recurrence after PV isolation. In addition, the rate of cardiovascular death and the rate of major adverse cardiovascular events will be assessed in relation to the enlargement of the left atrium and the volume of epicardial adipose tissue surrounding the heart.
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24
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Truong VT, Chung E, Nagueh S, Kereiakes D, Schaaf J, Volz B, Ngo TNM, Mazur W. Effect of transcatheter aortic valve replacement on left atrial function. Echocardiography 2018; 35:1713-1720. [PMID: 30079522 DOI: 10.1111/echo.14109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To investigate the effect of transcatheter aortic valve replacement on left atrial volumetric function and left atrial volume for the prediction of adverse outcomes. METHODS This is a retrospective analysis of 121 patients in sinus rhythm who underwent TAVR for severe AS. Maximum LA volume index (LAVI max), minimum LA volume index (LAVI min), and "pre-A" volume index (LAVIpre-A, the volume before atrial contraction) were measured by biplane Simpson's method at baseline, 1 month, and 1 year. The reservoir function, conduit function, booster pump function were calculated. All patients were followed for new-onset of atrial fibrillation, hospitalization and all-cause mortality. RESULTS The reservoir function, conduit function and booster function before TAVR were 46%, 21%, 32%, respectively. LA volumetric function assessment demonstrated that reservoir function, conduit function increased over the time (all P < 0.01). There was no difference in booster function after TAVR (P = 0.18). Baseline markedly enlarged LA was significantly increased for AF (HR: 4.72; 95% CI, 1.11-20.13, P = 0.04). In addition, There was a progressive decrease in LAVI max (P = 0.02) and RVSP (P = 0.03) over the time in non-AF group but not in AF group (P = 0.62 and P = 0.65, respectively). Although, the proportion of high left ventricular filling pressure decreased in both groups but a marked decrease was noted in non AF group in compared with AF group. CONCLUSION Reservoir function, conduit function increased over time. Lack of negative LA remodeling post TAVR was associated with higher incidence of AF.
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Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, Cincinnati, Ohio.,Tan Tao University School of Medicine, Tan Duc Ecity, Vietnam
| | - Eugene Chung
- The Christ Hospital Health Network, Cincinnati, Ohio
| | - Sherif Nagueh
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | | | - Brian Volz
- The Christ Hospital Health Network, Cincinnati, Ohio
| | - Tam N M Ngo
- Tan Tao University School of Medicine, Tan Duc Ecity, Vietnam
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25
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Ecker V, Knoery C, Rushworth G, Rudd I, Ortner A, Begley D, Leslie SJ. A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation. Clin Cardiol 2018; 41:862-870. [PMID: 29878481 DOI: 10.1002/clc.22931] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation is the most common heart-rhythm disorder, affecting about 1.5% to 2% of the population with an increased risk of mortality and morbidity due to stroke, thromboembolism, and heart failure. If the conversion back to sinus rhythm does not happen spontaneously, pharmacological or electrical cardioversion (ECV) is the next available treatment options for some patients. However, the long-term success following ECV is variable. This review describes the factors that are associated with maintenance of sinus rhythm following ECV and proposes a clinical strategy based on the available evidence.
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Affiliation(s)
- Veronika Ecker
- Institute for Pharmaceutical Sciences, Karl-Franzens-Universität, Graz, Austria
| | - Charles Knoery
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK
| | - Gordon Rushworth
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK.,Highland Pharmacy Education & Research Centre, Centre for Health Science, Inverness, UK
| | - Ian Rudd
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK
| | - Astrid Ortner
- Institute for Pharmaceutical Sciences, Karl-Franzens-Universität, Graz, Austria
| | - David Begley
- Cardiac Department, Royal Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Stephen J Leslie
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK.,Department of Diabetes & Cardiovascular Science, University of the Highlands and Islands, Centre for Health Science, Inverness, UK
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26
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Mulukutla S, Althouse AD, Jain SK, Saba S. Increased left atrial size is associated with higher atrial fibrillation recurrence in patients treated with antiarrhythmic medications. Clin Cardiol 2018; 41:825-829. [PMID: 29672879 DOI: 10.1002/clc.22964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is highly prevalent, and antiarrhythmic therapy is often used to help with rhythm control. Some common echocardiographic parameters may be useful in predicting AF recurrence among these patients. The purpose of this study was to evaluate the association between 3 common echocardiographic parameters (left atrial [LA] size, left ventricular ejection fraction [LVEF], and mitral regurgitation [MR]) and AF recurrence among patients treated with antiarrhythmic medications. HYPOTHESIS We hypothesized that LA size, LVEF, and severity of MR are predictors of AF recurrence in this population. METHODS A real-world cohort of AF patients who had transthoracic echocardiograms was analyzed. Data on LA size, LVEF, and MR were collected retrospectively from echocardiography reports. Patients were followed from the time of the echocardiogram until first recurrence of AF. RESULTS A total of 2522 patients had echocardiography reports available for review. LA size showed the strongest prognostic relationship with AF recurrence; neither LVEF nor MR was significantly associated with AF recurrence. These results persisted after adjusting for age, sex, race, tobacco use, alcohol use, drug use, body mass index, and Charlson Comorbidity Index in a multivariable model. CONCLUSIONS In a cohort of patients treated with antiarrhythmic medications that had transthoracic echocardiogram data, LA size was a significant predictor of AF recurrence. The clinical utility of this finding would be strengthened by replication in a multicenter setting.
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Affiliation(s)
- Saarang Mulukutla
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrew D Althouse
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Samir Saba
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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27
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Kehl D, Zimmer R, Sudan M, Kedan I. Handheld Ultrasound as a Novel Predictive Tool in Atrial Fibrillation: Prediction of Outcomes Following Electrical Cardioversion. JMIR Cardio 2018; 2:e7. [PMID: 31758780 PMCID: PMC6834228 DOI: 10.2196/cardio.9534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Atrial fibrillation (AF) recurrence after successful direct current cardioversion (CV) is common, and clinical predictors may be useful. We evaluated the risk of early AF recurrence according to inferior vena cava (IVC) measurements by handheld ultrasound (HHU) at the time of CV. Objective Assess HHU and objectively obtained measurements acquired at the point of care as potential clinical predictors of future clinical outcomes in patients with AF undergoing CV. Methods Maximum IVC diameter (IVCd) and collapsibility with inspiration were measured by the Vscan HHU (General Electric Healthcare Division) in 128 patients immediately before and after successful CV for AF. Patients were followed by chart review for recurrence of AF. Results Mean IVCd was 2.16 cm in AF pre-CV and 2.01 cm in sinus rhythm post-CV (P<.001). AF recurred within 30 days of CV in 34 of 128 patients (26.6%). Among patients with IVCd <2.1 cm pre-CV and decrease in IVCd post-CV, AF recurrence was 12.1%, compared to 31.6% in patients not meeting these parameters (odds ratio [OR] 0.299, P=.04). This association persisted after adjustment for age, ejection fraction <50%, left atrial enlargement, and amiodarone use (adjusted OR 0.185, P=.01). Among patients with IVCd post-CV <1.7 cm, AF recurrence was 13.5%, compared to 31.9% in patients not meeting this parameter (OR 0.185, P=.01). IVC parameters did not predict AF recurrence at 180 or 365 days. Conclusions The presence of a normal IVCd pre-CV that becomes smaller post-CV and the presence of a small IVCd post-CV were each independently associated with reduced likelihood of early, but not late, AF recurrence. HHU assessment of IVCd at the time of CV may be useful to identify patients at low risk of early recurrence of AF after CV.
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Affiliation(s)
- Devin Kehl
- Palo Alto Foundation Medical Group, Palo Alto, California, CA, United States.,Cedars Sinai Heart Institute, Beverly Hills, CA, United States
| | - Raymond Zimmer
- Cedars Sinai Heart Institute, Beverly Hills, CA, United States
| | - Madhuri Sudan
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, United States.,Department of Public Health, Aarhus University, Aarhus, Denmark.,College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States
| | - Ilan Kedan
- Cedars Sinai Heart Institute, Beverly Hills, CA, United States
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28
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Zhang Q, Wang JF, Dong QQ, Yan Q, Luo XH, Wu XY, Liu J, Sun YP. Evaluation of left atrial volume and function using single-beat real-time three-dimensional echocardiography in atrial fibrillation patients. BMC Med Imaging 2017; 17:44. [PMID: 28732493 PMCID: PMC5521085 DOI: 10.1186/s12880-017-0215-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was aimed to evaluate the feasibility and accuracy of real-time three-dimensional echocardiography (RT-3DE) measurement of left atrial (LA) volume and function in comparison with two-dimensional echocardiography (2DE) measurements in atrial fibrillation (AF) patients. METHODS A total of 50 pairs of AF patients and healthy controls were enrolled in this study. Indexed LA end-diastole volume (ILAEDV) and indexed LA end-systolic volume (ILAESV), as well as LA function indices such as segmental LA ejection fraction (LAEF), were assessed using 2DE Simpson's method and the RT-3DE method. RESULTS The images showed that regional LA volume-time curves and LAEF were disordered in AF patients. ILAEDV and ILAESV were markedly increased and global LAEF was significantly decreased in AF patients compared with those in healthy controls (P < 0.01). No significant differences were found in ILAEDV, ILAESV, and LAEF levels as determined by the RT-3DE method or 2DE Simpson's method. Bland-Altman analysis showed that the two methods agreed well for measuring ILAEDV, ILAESV, and segmental LAEF. CONCLUSION The RT-3DE method may be a feasible and accurate method for evaluating LA volume and function of AF patients in clinical practice.
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Affiliation(s)
- Qian Zhang
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Ju-Fang Wang
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Qing-Qing Dong
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Qing Yan
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Xiang-Hong Luo
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Xue-Ying Wu
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Jian Liu
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China
| | - Ya-Ping Sun
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Hai Ning Road, Shanghai, 200080, China.
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29
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Toufan M, Kazemi B, Molazadeh N. The significance of the left atrial volume index in prediction of atrial fibrillation recurrence after electrical cardioversion. J Cardiovasc Thorac Res 2017; 9:54-59. [PMID: 28451089 PMCID: PMC5402028 DOI: 10.15171/jcvtr.2017.08] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/13/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction: Electrical cardioversion (ECV) is a safe method for the treatment of atrial
fibrillation. It seems that left atrial volume index (LAVI) could be a good marker in predicting the
success of ECV. The purpose of this study is to assess of the significance of LAVI measurement
before ECV in predicting the recurrence of the AF.
Methods: Fifty-one patients with AF, selected for ECV were studied in the cardiology department
of Tabriz University of medical sciences. The clinical and demographic data of all the patients
were obtained. Echocardiography was performed before and also three months after ECV.
Patients were separated into two groups: those who maintained SR and those with relapse of AF
diagnosed by clinical manifestations and electrocardiography (ECG).
Results: Sinus rhythm (SR) was maintained in 76.5 percent of the patients following the three
months after ECV. The age, sex and the body mass index (BMI) were not significantly different
between SR and AF groups. Two groups showed no significant differences considering pre-ECV
medical history including medications and systemic diseases. The initial LAVI of SR group was
42.21±12.4 mL/m2 and AF group was 96.08±52.21 mL/m2, the initial LAVI was significantly
different between two groups (P = 0.000). The LAVI of SR group decreased significantly (5.69±0.74
mL/m2) after three months, LAVI decreased from 42.21 ± 12.4 ml/m2 to 37.51 ± 10.52 mL/m2.
(P = 0.000). The cut-off point of LAVI value in predicting the maintenance of SR was 55 mL/m2.
Conclusion: The present study indicates that LAVI is a powerful forecaster of the recurrence of
AF after ECV. The LAVI measurement could be a useful method in the selection of the patients
with AF for ECV.
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Affiliation(s)
- Mehrnoush Toufan
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Kazemi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negin Molazadeh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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30
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Matějková A, Šteiner I. Association of Atrial Fibrillation with Morphological and Electrophysiological Changes of the Atrial Myocardium. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 59:43-9. [PMID: 27526304 DOI: 10.14712/18059694.2016.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. For long time it was considered as pure functional disorder, but in recent years, there were identified atrial locations, which are involved in the initiation and maintenance of this arrhythmia. These structural changes, so called remodelation, start at electric level and later they affect contractility and morphology. In this study we attempted to find a possible relation between morphological (scarring, amyloidosis, left atrial (LA) enlargement) and electrophysiological (ECG features) changes in patients with AF. We examined grossly and histologically 100 hearts of necropsy patients - 54 with a history of AF and 46 without AF. Premortem ECGs were evaluated. The patients with AF had significantly heavier heart, larger LA, more severely scarred myocardium of the LA and atrial septum, and more severe amyloidosis in both atria. Severity of amyloidosis was higher in LAs vs. right atria (RAs). Distribution of both fibrosis and amyloidosis was irregular. The most affected area was in the LA anterior wall. Patients with a history of AF and with most severe amyloidosis have more often abnormally long P waves. Finding of long P wave may contribute to diagnosis of a hitherto undisclosed atrial fibrillation.
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Affiliation(s)
- Adéla Matějková
- Charles University, Faculty of Medicine and University Hospital in Hradec Králové, Fingerland Department of Pathology, Hradec Králové, Czech Republic.
| | - Ivo Šteiner
- Charles University, Faculty of Medicine and University Hospital in Hradec Králové, Fingerland Department of Pathology, Hradec Králové, Czech Republic
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31
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Mah DY, Shakti D, Gauvreau K, Colan SD, Alexander ME, Abrams DJ, Brown DW. Relation of Left Atrial Size to Atrial Fibrillation in Patients Aged ≤22 Years. Am J Cardiol 2017; 119:52-56. [PMID: 27780555 DOI: 10.1016/j.amjcard.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022]
Abstract
Left atrial (LA) dilation has been shown to be associated with atrial fibrillation (AF) in the adult population, with some studies indicating that larger LAs are more prone to AF recurrence. The relation of LA size to AF in the pediatric and young adult population has not been investigated. In this study, all pediatric patients (aged ≤22 years) who presented to Boston Children's Hospital from January 2002 to December 2012 with AF were reviewed. Patients with significant congenital heart disease, cardiomyopathies, proven channelopathies, previous cardiac surgery, end-stage renal disease, or severe lung disease/cystic fibrosis were excluded. LA measurements were taken using the echocardiogram performed at the initial presentation. In total, 48 patients with AF were identified. The median age at presentation was 17.1 years (range 3.7 to 22.9 years); 38 patients (79%) were men. Eleven patients (23%) had at least 1 recurrence of their AF. There was no difference in body mass index, prevalence of systemic hypertension, alcohol, stimulant, or illicit drug use between those who had an isolated episode of AF and those who had a recurrence. There was no significant difference in LA dimension Z-scores between groups, with only 2 patients (1 isolated AF, 1 recurrent AF) having Z-scores >2. In conclusion, AF in the young without underlying heart disease is not associated with LA dilation.
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32
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Yang Q, Qi X, Dang Y, Li Y, Song X, Hao X. Effects of atorvastatin on atrial remodeling in a rabbit model of atrial fibrillation produced by rapid atrial pacing. BMC Cardiovasc Disord 2016; 16:142. [PMID: 27342818 PMCID: PMC4921022 DOI: 10.1186/s12872-016-0301-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 05/27/2016] [Indexed: 12/19/2022] Open
Abstract
Background Accumulating evidence suggests that myeloperoxidase (MPO) is involved in atrial remodeling of atrial fibrillation (AF). Statins could reduce the MPO levels in patients with cardiovascular diseases. This study evaluated the effects of atorvastatin on MPO level and atrial remodeling in a rabbit model of pacing-induced AF. Methods Eighteen rabbits were randomly divided into sham, control and atorvastatin groups. Rabbits in the control and atorvastatin groups were subjected to rapid atrial pacing (RAP) at 600 bpm for 3 weeks, and treated with placebo or atorvastatin (2.5 mg/kg/d), respectively. Rabbits in the sham group did not receive RAP. After 3 weeks of pacing, atrial structural and functional changes were assessed by echocardiography, atrial effective refractory period (AERP) and AF inducibility were measured by atrial electrophysiological examination, and histological changes were evaluated by Masson trichrome-staining. The L-type calcium channel α1c (Cav1.2), collagen I and III, MPO, matrix metalloproteinase (MMP)-2 and MMP-9 were analyzed by real time polymerase chain reaction and/or western blot. Results All rabbits were found to have maintained sinus rhythm after 3 weeks of RAP. Atrial burst stimulation induced sustained AF (>30 min) in 5, 4, and no rabbits in the control, atorvastatin, and sham groups, respectively. The AERP shortened and Cav1.2 mRNA level decreased in the control group, but these changes were suppressed in the atorvastatin group. Obvious left atrial enlargement and dysfunction was found in both control and atorvastatin groups. Compared with the control group, these echocardiograhic indices of left atrium did not differ in the atorvastatin group. Prominent atrial fibrosis and increased levels of collagen I and III were observed in the control group but not in the atorvastatin group. The mRNA and protein levels of MPO, MMP-2 and MMP-9 significantly increased in the control group, but these changes were prevented in the atorvastatin group. Conclusion Treatment with atorvastatin prevented atrial remodeling in a rabbit model of RAP-induced AF. The reduction of levels of atrial MPO, MMP-2 and MMP-9 may contribute to the prevention of atorvastatin on atrial remodeling.
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Affiliation(s)
- Qian Yang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China.,Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, People's Republic of China
| | - Xiaoyong Qi
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China. .,Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, People's Republic of China.
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, People's Republic of China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, People's Republic of China
| | - Xuelian Song
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, People's Republic of China
| | - Xiao Hao
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, People's Republic of China
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Ballo P, Nistri S, Galderisi M, Mele D, Rossi A, Dini FL, Olivotto I, Losi MA, D'Andrea A, Zuppiroli A, Santoro GM, Mondillo S, Gentile F. Determinants of discrepancies between two-dimensional echocardiographic methods for assessment of maximal left atrial volume. Eur Heart J Cardiovasc Imaging 2016; 18:584-602. [DOI: 10.1093/ehjci/jew067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/07/2016] [Indexed: 12/26/2022] Open
Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Donato Mele
- Department of Cardiology, University of Ferrara, Ferrara, Italy
| | - Andrea Rossi
- Cardiology Division, Borgo Trento Hospital, Verona, Italy
| | - Frank L. Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Iacopo Olivotto
- Careggi University Hospital, Referral Center for Cardiomyopathies, Florence, Italy
| | - Maria Angela Losi
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy
| | | | | | | | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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Goldberger JJ, Arora R, Green D, Greenland P, Lee DC, Lloyd-Jones DM, Markl M, Ng J, Shah SJ. Evaluating the Atrial Myopathy Underlying Atrial Fibrillation: Identifying the Arrhythmogenic and Thrombogenic Substrate. Circulation 2015. [PMID: 26216085 DOI: 10.1161/circulationaha.115.016795] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial disease or myopathy forms the substrate for atrial fibrillation (AF) and underlies the potential for atrial thrombus formation and subsequent stroke. Current diagnostic approaches in patients with AF focus on identifying clinical predictors with the evaluation of left atrial size by echocardiography serving as the sole measure specifically evaluating the atrium. Although the atrial substrate underlying AF is likely developing for years before the onset of AF, there is no current evaluation to identify the preclinical atrial myopathy. Atrial fibrosis is 1 component of the atrial substrate that has garnered recent attention based on newer MRI techniques that have been applied to visualize atrial fibrosis in humans with prognostic implications regarding the success of treatment. Advanced ECG signal processing, echocardiographic techniques, and MRI imaging of fibrosis and flow provide up-to-date approaches to evaluate the atrial myopathy underlying AF. Although thromboembolic risk is currently defined by clinical scores, their predictive value is mediocre. Evaluation of stasis via imaging and biomarkers associated with thrombogenesis may provide enhanced approaches to assess risk for stroke in patients with AF. Better delineation of the atrial myopathy that serves as the substrate for AF and thromboembolic complications might improve treatment outcomes. Furthermore, better delineation of the pathophysiologic mechanisms underlying the development of the atrial substrate for AF, particularly in its earlier stages, could help identify blood and imaging biomarkers that could be useful to assess risk for developing new-onset AF and suggest specific pathways that could be targeted for prevention.
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Affiliation(s)
- Jeffrey J Goldberger
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Rishi Arora
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Green
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Philip Greenland
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel C Lee
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Donald M Lloyd-Jones
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Markl
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jason Ng
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sanjiv J Shah
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
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Wang J, Song S, Xie C, Han J, Li Y, Shi J, Xin M, Wang J, Luo T, Meng X, Yang B. MicroRNA profiling in the left atrium in patients with non-valvular paroxysmal atrial fibrillation. BMC Cardiovasc Disord 2015; 15:97. [PMID: 26319023 PMCID: PMC4553004 DOI: 10.1186/s12872-015-0085-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 08/10/2015] [Indexed: 02/02/2023] Open
Abstract
Background We aimed to identify the miRNA expression profiles in left atrial appendage, with the intention of identifying miRNAs that were significantly associated with non-valvular paroxysmal AF. Methods The RNA samples were isolated from healthy controls (n = 5) and patients with atrial fibrillation (n = 8). To confirm the findings obtained by analyzing the miRNA profile, we measured the expression of selected miRNAs in the entire cohort by quantitative PCR. Results Ten specific miRNAs were found to be differentially expressed between atrial fibrillation and healthy controls with more than a 2-fold change (P < 0.05). Consistent with the data obtained for the profile, expression levels of miRNA-155, miRNA-146b-5p and miRNA-19b were significantly increased in patients with atrial fibrillation. Interestingly, levels of miRNA-146b-5p and miRNA-155, which are known to be associated with inflammation, were independently and positively associated with left atrium dimension, atrial fibrillation duration and high sensitivity C-reactive protein levels. By using four Databases (TargetScan, miRanda, Starbase Clip-seq and miRDB) to perform target gene prediction, there were four genes were related to the inflammatory response and fibrosis, and three others encoding cardiac ion channel proteins. As a result of TaqMan qPCR and Western analysis, the relative mRNA and protein expression level of three target genes (DIER-1, TIMP-4 and CACNA1C) were significantly lower in the atrial fibrillation group than that in the healthy control group. Conclusions Expression of inflammation-associated miRNAs is significantly up-regulated in the left atrial appendage of patients with non-valvular paroxysmal atrial fibrillation, which may play a significant role in electrical and structural remodeling. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0085-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Shiqiu Song
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Changqing Xie
- Department of Internal Medicine, Vidant Medical Center, Broody School of Medicine, East Carolina University, Greenville, North Carolina, 27834, USA.
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Yan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Jiahai Shi
- Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China.
| | - Meng Xin
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Jun Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Tiange Luo
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R. China.
| | - Bo Yang
- University of Michigan Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, 48109, USA.
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Heo R, Hong GR, Kim YJ, Mancina J, Cho IJ, Shim CY, Chang HJ, Ha JW, Chung N. Automated quantification of left atrial size using three-beat averaging real-time three dimensional Echocardiography in patients with atrial fibrillation. Cardiovasc Ultrasound 2015; 13:38. [PMID: 26306693 PMCID: PMC4548448 DOI: 10.1186/s12947-015-0032-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 08/13/2015] [Indexed: 11/20/2022] Open
Abstract
Background Left atrial (LA) sizing in patients with atrial fibrillation (AF) is crucial for follow-up and outcome. Recently, the automated quantification of LA using the novel three-beat averaging real-time three dimensional echocardiography (3BA-RT3DE) is introduced. The aim of this study was to assess the feasibility and accuracy of 3BA-RT3DE in patients with atrial fibrillation (AF). Methods Thirty-one patients with AF (62.8 ± 11.7 years, 67.7 % male) were prospectively recruited to have two dimensional echocardiography (2DE) and 3BA-RT3DE (SC 2000, ACUSON, USA). The maximal left atrial (LA) volume was measured by the conventional prolate-ellipse (PE) and area-length (AL) method using three-beat averaging 2D transthoracic echocardiography and automated software analysis (eSie volume analysis, Siemens Medical Solution, Mountain view, USA); measurements were compared with those obtained by computed tomography (CT). Results Maximal LA volume by 3BA-RT3DE was feasible for all patients. LA volume was 68.4 ± 28.2 by PE-2DE, 89.2 ± 33.1 by AL-2DE, 100.6 ± 31.8 by 3BA-RT3DE, and 131.2 ± 42.2 mL by CT. LA volume from PE-2DE (R2 = 0.48, p < 0.001, ICC = 0.64, p < 0.001), AL-2DE (R2 = 0.47, p < 0.001, ICC = 0.67, p < 0.001), and 3BA-RT3DE (R2 = 0.50, p = 0.001, ICC = 0.65, p < 0.001) showed significant correlations with CT. However, 3BA-RT3DE demonstrated a small degree of underestimation (30.5 mL) of LA volume compared to 2DE-based measurements. Good-quality images from 3BA-RT3DE (n = 16) showed a significantly tighter correlation with images from CT scanning (R2 = 0.60, p = 0.0004, ICC = 0.76, p < 0.001) compared to those of fair quality. Conclusion Automated quantification of LA volume using 3BA-RT3DE is feasible and accurate in patients with AF. An image of good quality is essential for maximizing the value of this method in clinical practice.
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Affiliation(s)
- Ran Heo
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Young-Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joel Mancina
- Ultrasound Division, Siemens Medical Solution, Mountain View, CA, USA
| | - In-Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Im SI, Na JO, Kim SW, Choi CU, Kim JW, Yong HS, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Lim HE. Adjusted left atrial emptying fraction as a predictor of procedural outcome after catheter ablation for atrial fibrillation. Tex Heart Inst J 2015; 42:216-25. [PMID: 26175632 DOI: 10.14503/thij-14-4524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Structural remodeling of the left atrium is a risk factor for recurrent arrhythmia after catheter ablation for atrial fibrillation; however, data are sparse regarding the role of functional left atrial remodeling in predicting procedural outcomes. We evaluated whether left atrial transport function could be used to predict recurrent atrial fibrillation. From July 2008 through August 2010, we enrolled 202 consecutive patients who underwent catheter ablation for atrial fibrillation (paroxysmal=120, persistent=82). Left atrial volumes (LAVs) were measured by means of multislice computed tomography at every 10% of the R-R interval, and measurements were adjusted for body surface area to yield the LAV index (LAVI) at baseline. The left atrial emptying fraction (LAEF) was calculated according to LAV differences. During the mean follow-up period of 10 ± 4 months after a single ablation procedure, atrial fibrillation recurred in 59 patients (paroxysmal=19, persistent=40). Multivariate analysis revealed that persistent atrial fibrillation, early mitral inflow velocity, LAVImax, LAVImin, LAEF, LAVImax/LAEF, and LAVImin/LAEF were all independent predictors of atrial fibrillation, but the best predictor was LAVImin/LAEF (β=1.329, P=0.001). The cutoff value was 1.61 (mL/m(2))/%, and the sensitivity and specificity were 74.6% and 62.2%, respectively (area under the curve=0.761). Our study shows that adjusted left atrial emptying fraction with use of multislice computed tomography might be a useful, noninvasive method to select patients for ablation.
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Pan G, Zhou X, Zhao J. Effect of telmisartan on atrial fibrillation recurrences in patients with hypertension: a systematic review and meta-analysis. Cardiovasc Ther 2015; 32:184-8. [PMID: 24645740 DOI: 10.1111/1755-5922.12073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The systematic review and meta-analysis are to evaluate the effect of t Telmisartan on atrial fibrillation (AF) recurrences in hypertensive patients with paroxysmal AF. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. Random controlled trials (RCTs) were conducted in which telmisartan was compared to other antihypertensive drugs for AF recurrences prevention in hypertensive patients with paroxysmal AF. A systematic review and meta-analysis based on aggregate data extracted from the included studies were carried out to assess the telmisartan in preventing AF relapse. The efficacy outcome was the incidence of AF recurrences. Hazard ratios (HRs) were calculated from published summary statistics and combined to give pooled estimates of efficacy. RESULTS This meta-analysis comprised four studied including 1050 hypertensive patients (537 men and 513 women; mean age 63; mean blood pressure (BP) 156/94 mmHg). With the similar BP control, the AF recurrences rate was significantly lower in the telmisartan-treated patients than in the other antihypertensive drugs-treated patients (HR 0.54, CI 0.34-0.86, P < 0.05). CONCLUSION The results of this review and meta-analysis indicate that telmisartan seems to be more effective than other antihypertensive drugs in preventing AF recurrences among hypertensive patients with paroxysmal AF.
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Affiliation(s)
- Gaofeng Pan
- Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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When It Comes to Atrial Fibrillation Recurrence, Perhaps We Should Look Both Left and Right. Can J Cardiol 2015; 31:17-9. [DOI: 10.1016/j.cjca.2014.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 11/20/2014] [Accepted: 11/20/2014] [Indexed: 12/23/2022] Open
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Luong C, Thompson DJS, Bennett M, Gin K, Jue J, Barnes ME, Colley P, Tsang TSM. Right atrial volume is superior to left atrial volume for prediction of atrial fibrillation recurrence after direct current cardioversion. Can J Cardiol 2014; 31:29-35. [PMID: 25547547 DOI: 10.1016/j.cjca.2014.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The value of right atrial volume as a predictor for recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV) is unknown. METHODS We sought to compare the performance of right atrial volume indexed to body surface area (RAVI), left atrial diameter, left atrial volume indexed to body surface area (LAVI), and biatrial volume index (BAVI) for the prediction of AF recurrence at 6 months after DCCV. This study included the first 95 consecutive patients from the AF Clinic at a large tertiary care hospital who underwent DCCV and who had an echocardiogram available within 6 months before DCCV. Maximal LAVI, RAVI, and BAVI were determined from the echocardiogram before DCCV. Electrocardiographic and clinical data were acquired at baseline, before cardioversion, and at each clinic visit. RESULTS Of the 95 patients (64 male; mean age, 63 ± 12 years), history of systemic hypertension, diabetes mellitus, heart failure, and transient ischemic attack/stroke was present in 60 (63%), 14 (15%), 27 (28%), and 5 (5%) patients, respectively. Mean duration from AF diagnosis to DCCV was 3.5 ± 5.0 years. At 6 months after DCCV, 53 (56%) had reverted to AF. RAVI had superior predictive ability (area under the receiver operator characteristic curve: RAVI, 0.77; left atrial diameter, 0.54; LAVI, 0.64; and BAVI, 0.70). RAVI ≥ 42 mL/m(2) provided the best accuracy for prediction of recurrence (76% accuracy, 71% sensitivity, 83% specificity, 90% positive predictive value, and 56% negative predictive value). Best accuracy for LAVI was ≥ 48 mL/m(2) (70% accuracy, 53% sensitivity, 79% specificity, 85% positive predictive value; 43% negative predictive value). CONCLUSIONS RAVI is superior to LAVI for the prediction of AF recurrence at 6 months after DCCV.
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Affiliation(s)
- Christina Luong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darby J S Thompson
- EMMES Canada, Burnaby, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Matthew Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Gin
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Jue
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marion E Barnes
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pamela Colley
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa S M Tsang
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Fornengo C, Antolini M, Frea S, Gallo C, Grosso Marra W, Morello M, Gaita F. Prediction of atrial fibrillation recurrence after cardioversion in patients with left-atrial dilation. Eur Heart J Cardiovasc Imaging 2014; 16:335-41. [PMID: 25274966 DOI: 10.1093/ehjci/jeu193] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Little is known about the impact of left-ventricular (LV) diastolic dysfunction on risk of atrial fibrillation (AF) recurrence in patients with left-atrial (LA) dilation. To evaluate, in patients with symptomatic persistent AF and LA dilation, the incremental role of LV diastolic dysfunction in predicting early AF recurrence after cardioversion (CV). METHODS AND RESULTS From July 2011 to July 2013, 175 patients with persistent AF referred to our centre for CV were screened. Inclusion criteria were: European Heart Rhythm Association (EHRA) class ≥2 despite optimal medical treatment and heart rate at rest ≤80 bpm, LA volume ≥34 mL/m(2), EF > 35%, absence of untreated ischaemic disease and significant valvular disease, successful CV. Finally, 127 patients (age 64 ± 10 years, 60% EHRA ≥3, LA volume 42 ± 15 mL/m(2)) were enrolled. At 3 months, 37 (29%) patients presented AF recurrence. At univariate analysis, AF duration >90 days before CV (P < 0.01), septal e' <8 cm/s (P 0.03), and septal E/e' ratio ≥11 (P < 0.001) but no LA dimensions significantly correlated with AF recurrence. Logistic regression analysis confirmed septal E/e' ratio ≥11 as the best predictor of recurrence (OR 3.25 95% CI 1.19-8.86 P 0.001) together with an AF duration >90 days before the CV (OR 2.69 95% CI 1.01-7.53 P 0.04). At ROC curve analysis, the septal E/e' ratio ≥11 showed the best diagnostic accuracy (AUC 0.66, 95% CI 0.55-0.76, P 0.007). CONCLUSION In this population with symptomatic persistent AF and LA enlargement, septal E/e' ratio ≥11 and AF duration >90 days predicted AF recurrence at 3 months.
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Affiliation(s)
- Cristina Fornengo
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy
| | - Marina Antolini
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy
| | - Cristina Gallo
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy
| | - Walter Grosso Marra
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy
| | - Mara Morello
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and University of Turin, C.so Bramante 88/90, Turin 10126, Italy
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Stojanovska J, Cronin P, Gross BH, Kazerooni EA, Tsodikov A, Frank L, Oral H. Left atrial function and maximum volume as determined by MDCT are independently associated with atrial fibrillation. Acad Radiol 2014; 21:1162-71. [PMID: 25022763 DOI: 10.1016/j.acra.2014.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/18/2014] [Accepted: 02/12/2014] [Indexed: 01/13/2023]
Abstract
RATIONALE AND OBJECTIVES To assess whether left atrial (LA) volume, function, and diameter as determined by multidetector computed tomography (MDCT) are associated with the presence and chronicity of atrial fibrillation (AF). MATERIALS AND METHODS A total of 232 subjects, 156 with AF (43 with chronic and 113 with paroxysmal) and 76 normal subjects, formed the study population. AF subjects underwent MDCT of the pulmonary veins and LA, and normal subjects underwent coronary computed tomography (CT), on which LA volume, function, and diameter were measured. Associations between each MDCT LA parameter and presence and chronicity of AF were assessed using logistic regression analysis. RESULTS The indexed LA maximum volume (odds ratio [OR]=2.42; 95% confidence interval [CI], 1.43-4.08; P=.0009) was significantly associated with chronicity and presence of AF (OR=1.06; 95% CI, 1.03-1.10; P=.0003) after adjustment for traditional risk factors. The LA function was associated with presence of AF (OR=0.93; 95% CI, 0.89-0.97; P=.0005), but not with AF chronicity (OR=1.12; 95% CI, 0.93-1.33; P=.21). CONCLUSIONS Decreased LA function is associated with presence of AF, and increased LA maximum volume is associated with presence and chronicity of AF, independent of traditional risk factors.
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Affiliation(s)
- Jadranka Stojanovska
- Department of Radiology, University of Michigan Hospitals, B1 132H Taubman, Center/5302, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5302.
| | - Paul Cronin
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Barry H Gross
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Alex Tsodikov
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Luba Frank
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Hakan Oral
- Division of Cardiovascular Medicine, Department of Internal Medicine, Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan
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Collier P, Watson CJ, Waterhouse DF, Dawkins IR, Patle AK, Horgan S, Conlon CM, O'Hanlon R, Baugh JA, Ledwidge MT, McDonald K. Progression of left atrial volume index in a population at risk for heart failure: a substudy of the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) trial. Eur J Heart Fail 2014; 14:957-64. [DOI: 10.1093/eurjhf/hfs084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Patrick Collier
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Chris J. Watson
- UCD Conway Institute of Biomolecular and Biomedical Research, Belfield; University College Dublin 4; Ireland
| | - Deidre F. Waterhouse
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Ian R. Dawkins
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Anil K. Patle
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Stephen Horgan
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Carmel M. Conlon
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Rory O'Hanlon
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - John A. Baugh
- UCD Conway Institute of Biomolecular and Biomedical Research, Belfield; University College Dublin 4; Ireland
| | - Mark T. Ledwidge
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Kenneth McDonald
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
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Gupta DK, Shah AM, Giugliano RP, Ruff CT, Antman EM, Grip LT, Deenadayalu N, Hoffman E, Patel I, Shi M, Mercuri M, Mitrovic V, Braunwald E, Solomon SD. Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48. Eur Heart J 2013; 35:1457-65. [PMID: 24302269 DOI: 10.1093/eurheartj/eht500] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS The complex relationship between left atrial (LA) structure and function, electrical burden of atrial fibrillation (AF) and stroke risk is not well understood. We aimed to describe LA structure and function in AF. METHODS AND RESULTS Left atrial structure and function was assessed in 971 subjects enrolled in the echocardiographic substudy of ENGAGE AF-TIMI 48. Left atrial size, emptying fraction (LAEF), and contractile function were compared across AF types (paroxysmal, persistent, or permanent) and CHADS2 scores as an estimate of stroke risk. The majority of AF patients (55%) had both LA enlargement and reduced LAEF, with an inverse relationship between LA size and LAEF (R = -0.57, P < 0.001). With an increasing electrical burden of AF and higher CHADS2 scores, LA size increased and LAEF declined. Moreover, 19% of AF subjects had impaired LAEF despite normal LA size, and LA contractile dysfunction was present even among the subset of AF subjects in sinus rhythm at the time of echocardiography. CONCLUSIONS In a contemporary AF population, LA structure and function were increasingly abnormal with a greater electrical burden of AF and higher stroke risk estimated by the CHADS2 score. Moreover, LA dysfunction was present despite normal LA size and sinus rhythm, suggesting that the assessment of LA function may add important incremental information in the evaluation of AF patients. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov; ID = NCT00781391.
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Affiliation(s)
- Deepak K Gupta
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Amil M Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elliott M Antman
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura T Grip
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Naveen Deenadayalu
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elaine Hoffman
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Minggao Shi
- Daiichi-Sankyo Pharma Development, Edison, NJ, USA
| | | | | | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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Obel O, Joglar JA. Unveiling the remodeled atrium: lessons from the early recurrence of atrial fibrillation. J Cardiovasc Electrophysiol 2013; 25:168-70. [PMID: 24237906 DOI: 10.1111/jce.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Owen Obel
- Division of Cardiology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Agner BFR, Kuhl JT, Linde JJ, Kofoed KF, Akeson P, Rasmussen BV, Jensen GB, Dixen U. Assessment of left atrial volume and function in patients with permanent atrial fibrillation: comparison of cardiac magnetic resonance imaging, 320-slice multi-detector computed tomography, and transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 2013; 15:532-40. [DOI: 10.1093/ehjci/jet239] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Müller P, Schiedat F, Bialek A, Bösche L, Ewers A, Kara K, Dietrich JW, Mügge A, Deneke T. Total atrial conduction time assessed by tissue doppler imaging (PA-TDI Interval) to predict early recurrence of persistent atrial fibrillation after successful electrical cardioversion. J Cardiovasc Electrophysiol 2013; 25:161-7. [PMID: 24118306 DOI: 10.1111/jce.12306] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 09/19/2013] [Accepted: 09/23/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether total atrial conduction time (TACT) assessed via tissue Doppler imaging (PA-TDI interval) can identify patients with early recurrent atrial fibrillation (ERAF) after successful direct-current electrical cardioversion (CV) of persistent atrial fibrillation (persPAF). METHODS AND RESULTS A total of 54 patients without antiarrhythmic drug medication (mean ± SD: 66 ± 10.4 years; 33% women) with persPAF and successful CV were enrolled between May 2012 and May 2013. TACT was measured 6 hours after successful CV in the left atrium by tissue Doppler imaging (PA-TDI interval). ERAF was determined via Holter-electrocardiogram over a period of 7 days after CV. Receiver opearting characteristic analysis was used to determine an optimal cutoff value of PA-TDI interval for prognosis of ERAF. Based on this result, recurrence-free survival was assessed with Mantel-Haenszel's log-rank test. ERAF occurred in 23 patients (43%). PA-TDI interval was longer in patients with ERAF compared to those who maintained sinus rhythm (mean ± SD: 163.5 ± 11.1 vs 132.3 ± 11.2 milliseconds; P < 0.00001). At the cutoff value of 152 milliseconds, PA-TDI interval sensitivity and specificity related to ERAF were 87% and 100%, respectively. CONCLUSION Measuring PA-TDI interval may help to predict ERAF after successful CV in patients with persAF.
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KOHÁRI MÁRIA, ZADO ERICA, MARCHLINSKI FRANCISE, CALLANS DAVIDJ, HAN YUCHI. Left Atrial Volume Best Predicts Recurrence after Catheter Ablation in Patients with Persistent and Longstanding Persistent Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:422-9. [DOI: 10.1111/pace.12279] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/19/2013] [Accepted: 08/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- MÁRIA KOHÁRI
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
- Second Department of Medicine; Cardiology Center, University of Szeged; Szeged Hungary
| | - ERICA ZADO
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - FRANCIS E. MARCHLINSKI
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - DAVID J. CALLANS
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - YUCHI HAN
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
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Plasma profiles of matrix metalloproteinases and tissue inhibitors of the metalloproteinases predict recurrence of atrial fibrillation following cardioversion. J Cardiovasc Transl Res 2013; 6:528-35. [PMID: 23722357 DOI: 10.1007/s12265-013-9471-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
Atrial fibrosis is considered to contribute to atrial fibrillation (AF) recurrence following cardioversion. This study tested the hypothesis that circulating levels of matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) can predict AF recurrence postcardioversion. Precardioversion plasma samples (n = 82) were assayed for MMPs (eight types), TIMPs (all four types), N-terminus pro B-type natriuretic peptide, and high-sensitivity C-reactive protein levels. Patients were followed for AF recurrence postcardioversion. Despite 100 % restoration of sinus rhythm, 36 (44 %) reverted to AF within 3 months. Left atrial volume was increased in patients in whom AF recurred. Precardioversion MMP-9 was higher and TIMP-4 lower with AF recurrence. MMP-9, MMP-3, and TIMP-4 independently predicted AF recurrence. In multivariate analysis, combination of MMP-9, MMP-3, and TIMP-4 increased prediction of AF recurrence. Circulating levels of MMPs and TIMPs predict AF recurrence postcardioversion and may be used in a novel biomarker panel to guide AF stratification and therapy.
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Melduni RM, Cullen MW. Role of Left Ventricular Diastolic Dysfunction in Predicting Atrial Fibrillation Recurrence after Successful Electrical Cardioversion. J Atr Fibrillation 2012; 5:654. [PMID: 28496792 PMCID: PMC3602956 DOI: 10.4022/jafib.654] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/04/2012] [Accepted: 10/24/2012] [Indexed: 12/14/2022]
Abstract
The role of left ventricular (LV) diastolic dysfunction in predicting atrial fibrillation (AF) recurrence after successful electrical cardioversion is largely unknown. Studies suggest that there may be a link between abnormal LV compliance and the initial development, and recurrence of AF after electrical cardioversion. Although direct-current cardioversion (DCCV) is a well-established and highly effective method to convert AF to sinus rhythm, it offers little else beyond immediate rate control because it does not address the underlying cause of AF. Preservation of sinus rhythm after successful cardioversion still remains a challenge for clinicians. Despite the use of antiarrhythmic drugs and serial cardioversions, the rate of AF recurrence remains high in the first year. Current evidence suggests that diastolic dysfunction, which is associated with atrial volume and pressure overload, may be a mechanism underlying the perpetuating cycle of AF recurrence following successful electrical cardioversion. Diastolic dysfunction is considered to be a defect in the ability of the myofibrils, which have shortened against a load in systole to eject blood into the high-pressure aorta, to rapidly or completely return to their resting length. Consequently, LV filling is impaired and the non-compliant left ventricle is unable to fill at low pressures. As a result, left atrial and pulmonary vein pressure rises, and electrical and structural remodeling of the atrial myocardium ensues, creating a vulnerable substrate for AF. In this article, we review the current evidence highlighting the association of LV diastolic dysfunction with AF recurrence after successful electrical cardioversion and provide an approach to the management of LV diastolic dysfunction to prevent AF recurrence.
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