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Masuda M, Uematsu H, Matsuda Y, Sugino A, Ooka H, Kudo S, Fujii S, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Hata Y, Nakao S, Mano T. Left atrial low voltage areas and heart failure in patients with atrial fibrillation: Implication of the atrial myopathy. ESC Heart Fail 2024. [PMID: 38853626 DOI: 10.1002/ehf2.14878] [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: 12/07/2023] [Revised: 04/26/2024] [Accepted: 05/12/2024] [Indexed: 06/11/2024] Open
Abstract
AIMS Atrial fibrillation (AF) and heart failure (HF) affect each other and are often co-morbid. The fact that HF development is not uncommon even after ablation suggests that we need a deeper understanding of the pathology of these conditions. Atrial myocardial degeneration is an underlying factor in AF patients and may be associated with HF development after ablation. This study aimed to investigate the impact of low-voltage areas (LVAs) on HF prognosis after AF ablation. METHODS AND RESULTS This observational study included 1481 consecutive patients undergoing initial ablation for AF. Left atrial LVAs were defined as regions with a bipolar peak-to-peak voltage of <0.50 mV. Patients were divided into three groups: no LVA (LVA size indexed to body surface area <3 cm2/m2, n = 1129), small LVA (3-10 cm2/m2, n = 217), and extensive LVA (≥10 cm2/m2, n = 135). A composite endpoint of HF hospitalization or death occurred more frequently in patients with larger LVAs (3.3% vs. 6.5% vs. 13.3%, P < 0.0001) during the 3-year follow up period. The extent of LVAs was independently related to the risk of the composite endpoint with an adjusted hazard ratio of 1.55 (95% confidence interval, 1.16-2.10) for each additional step of LVA classification (P = 0.003). CONCLUSIONS LVA presence and its extent were associated with frequent HF hospitalization and death. Underlying atrial myopathy appears to define a poor HF prognosis after AF ablation.
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Affiliation(s)
- Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | | | - Ayako Sugino
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Hirotaka Ooka
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Satoshi Kudo
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Subaru Fujii
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Sho Nakao
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
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Deering TF, Goyal SK, Bhimani AA, Hoosien M, Karimianpour A, Krishnasamy KP, Nilsson KR, Omar A, Lakkireddy D, Gopinathannair R, Katapadi A, Sohns C. Atrial fibrillation ablation in heart failure patients: Where do we stand in 2023? - State of the art review. Pacing Clin Electrophysiol 2024; 47:88-100. [PMID: 38071456 DOI: 10.1111/pace.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024]
Abstract
Atrial fibrillation (AF) and heart failure are common overlapping cardiovascular disorders. Despite important therapeutic advances over the past several decades, controversy persists about whether a rate control or rhythm control approach constitutes the best option in this population. There is also considerable debate about whether antiarrhythmic drug therapy or ablation is the best approach when rhythm control is pursued. A brief historical examination of the literature addressing this issue will be performed. An analysis of several important clinical outcomes observed in the prospective, randomized studies, which have compared AF ablation to non-ablation treatment options, will be discussed. This review will conclude with recommendations to guide clinicians on the status of AF ablation as a treatment option when considering management options in heart failure patients with atrial fibrillation.
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Affiliation(s)
- Thomas F Deering
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
- Department of Cardiology, Augusta University, Athens, Georgia, USA
| | - Sandeep K Goyal
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Ashish A Bhimani
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Michael Hoosien
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Ahmadreza Karimianpour
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Kavita P Krishnasamy
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Kent R Nilsson
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
- Department of Cardiology, Augusta University, Athens, Georgia, USA
| | - Abdullah Omar
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Aashish Katapadi
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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3
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Catheter Ablation for Atrial Fibrillation in Structural Heart Disease: A Review. J Clin Med 2023; 12:jcm12041431. [PMID: 36835964 PMCID: PMC9966488 DOI: 10.3390/jcm12041431] [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: 01/19/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Patients with structural heart disease (SHD) are at an increased risk of developing this arrhythmia and are particularly susceptible to the deleterious hemodynamic effects it carries. In the last two decades, catheter ablation (CA) has emerged as a valuable strategy for rhythm control and is currently part of the standard care for symptomatic relief in patients with AF. Growing evidence suggests that CA of AF may have potential benefits that extend beyond symptoms. In this review, we summarize the current knowledge of this intervention on SHD patients.
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Virk SA, Hyun K, Brieger D, Sy RW. Prognostic benefit of catheter ablation of atrial fibrillation in heart failure: An updated meta‐analysis of randomized controlled trials. J Arrhythm 2023; 39:129-141. [PMID: 37021020 PMCID: PMC10068943 DOI: 10.1002/joa3.12812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/30/2022] [Accepted: 12/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background The prognostic role of catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) remains uncertain, with guideline recommendations largely based on a single trial. We conducted a meta-analysis of randomized controlled trials (RCTs) assessing the prognostic impact of AF ablation in patients with HF. Methods Electronic databases were searched for RCTs comparing 'AF ablation' versus 'other care' (medical therapy and/or atrioventricular node ablation with pacing) in patients with HF. Primary endpoints were ≥1-year mortality, HF hospitalization and change in left ventricular ejection fraction (LVEF). Meta-analyses were performed using random-effects modelling. Results Nine RCTs (n = 1462) met inclusion criteria. Compared to 'other care', AF ablation significantly reduced ≥1-year mortality (relative risk [RR] 0.65; 95% confidence intervals [CI], 0.49-0.87) and HF hospitalization (RR 0.64; 95% CI, 0.51-0.81). AF ablation demonstrated significantly greater improvement in LVEF (mean difference [MD] 5.4; 95% CI, 4.4-6.4), 6-min walk test distance (MD 21.5 meters; 95% CI, 4.6-38.4) and quality of life as measured by Minnesota Living with Heart Failure Questionnaire score (MD 7.2; 95% CI, 2.8-11.7). Meta-regression analyses showed the beneficial impact of AF ablation on LVEF was significantly blunted by higher prevalence of ischaemic cardiomyopathy. Conclusions Our meta-analysis demonstrates AF ablation is superior to 'other care' in improving mortality, HF hospitalization, LVEF and quality of life in patients with HF. However, the highly selected study populations in included RCTs and effect modification mediated by etiology of HF suggests these benefits do not uniformly apply across the HF population.
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Affiliation(s)
- Sohaib A. Virk
- Department of Cardiology Concord Repatriation General Hospital Concord New South Wales Australia
| | - Karice Hyun
- Department of Cardiology Concord Repatriation General Hospital Concord New South Wales Australia
- Westmead Applied Research Centre University of Sydney New South Wales Australia
| | - David Brieger
- Department of Cardiology Concord Repatriation General Hospital Concord New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Raymond W. Sy
- Department of Cardiology Concord Repatriation General Hospital Concord New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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Martin AC, Bories MC, Tence N, Baudinaud P, Pechmajou L, Puscas T, Marijon E, Achouh P, Karam N. Epidemiology, Pathophysiology, and Management of Native Atrioventricular Valve Regurgitation in Heart Failure Patients. Front Cardiovasc Med 2021; 8:713658. [PMID: 34760937 PMCID: PMC8572852 DOI: 10.3389/fcvm.2021.713658] [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: 05/23/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Atrioventricular regurgitation is frequent in the setting of heart failure. It is due to atrial and ventricular remodelling, as well as rhythmic disturbances and loss of synchrony. Once atrioventricular regurgitation develops, it can aggravate the underlying heart failure, and further participate and aggravate its own severity. Its presence is therefore concomitantly a surrogate of advance disease and a predictor of mortality. Heart failure management, including medical therapy, cardiac resynchronization therapy, and restoration of sinus rhythm, are the initial steps to reduce atrioventricular regurgitation. In the current review, we analyse the current data assessing the epidemiology, pathophysiology, and impact of non-valvular intervention on atrioventricular regurgitation including medical treatment, cardiac resynchronization and atrial fibrillation ablation.
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Affiliation(s)
- Anne-Céline Martin
- Paris University, INSERM UMRS_1140, Paris, France.,Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France
| | - Marie-Cécile Bories
- Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France.,University of Paris, PARCC, INSERM, Paris, France
| | - Noemie Tence
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Pierre Baudinaud
- University of Paris, PARCC, INSERM, Paris, France.,Electrophysiology Unit, European Hospital Georges Pompidou, Paris, France
| | - Louis Pechmajou
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Tania Puscas
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Eloi Marijon
- University of Paris, PARCC, INSERM, Paris, France.,Electrophysiology Unit, European Hospital Georges Pompidou, Paris, France
| | - Paul Achouh
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Nicole Karam
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
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Cao X, Aimoto M, Nagasawa Y, Zhang HX, Zhang CS, Takahara A. Electrophysiological Response to Acehytisine Was Modulated by Aldosterone in Rats with Aorto-Venocaval Shunts. Biol Pharm Bull 2021; 44:1044-1049. [PMID: 34078775 DOI: 10.1248/bpb.b20-00974] [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] [Indexed: 11/22/2022]
Abstract
Aldosterone induces cardiac electrical and structural remodeling, which leads to the development of heart failure and/or atrial fibrillation (AF). However, it remains unknown whether aldosterone-induced remodeling may modulate the efficacy of anti-AF drugs. In this study, we aimed to jeopardize the structural and functional remodeling by aldosterone in rats with aorto-venocaval shunts (AVS rats) and evaluate the effect of acehytisine in this model. An AVS operation was performed on rats (n = 6, male) and it was accompanied by the intraperitoneal infusion of aldosterone (AVS + Ald) at 2.0 µg/h for 28 d. The cardiopathy was characterized by echocardiography, electrophysiologic and hemodynamic testing, and morphometric examination in comparison with sham-operated rats (n = 3), sham + Ald (n = 6), and AVS (n = 5). Aldosterone accelerated the progression from asymptomatic heart failure to overt heart failure and induced sustained AF resistant to electrical fibrillation in one out of six rats. In addition, it prolonged PR, QT interval and Wenckebach cycle length. Acehytisine failed to suppress AF in the AVS + Ald rats. In conclusion, aldosterone jeopardized electrical remodeling and blunted the electrophysiological response to acehytisine on AF.
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Affiliation(s)
- Xin Cao
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
| | - Megumi Aimoto
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
| | - Yoshinobu Nagasawa
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
| | - Han-Xiao Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine
| | - Cheng-Shun Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine
| | - Akira Takahara
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University
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