1
|
Kawakami H, Inoue K, Nagai T, Fujii A, Sasaki Y, Shikano Y, Sakuoka N, Miyazaki M, Takasuka Y, Ikeda S, Yamaguchi O. Persistence of left atrial abnormalities despite left atrial volume normalization after successful ablation of atrial fibrillation. J Arrhythm 2021; 37:1318-1329. [PMID: 34621431 PMCID: PMC8485788 DOI: 10.1002/joa3.12624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Left atrial volume index (LAVI) of >34 mL/m2 is the cutoff value for identifying an enlarged left atrium. The definition of left atrial (LA) reverse remodeling after atrial fibrillation (AF) ablation is undetermined. We hypothesized that patients with LA dilatation who achieve normal LA volume (LAVI<34 mL/m2) after AF ablation have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume can also achieve normal LA function with AF ablation. METHODS We enrolled 140 AF patients with baseline LAVI of ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 hour and at 1 year after the procedure. To define the normal range of LA function, age- and sex-matched controls without a history of AF were also enrolled. RESULTS After restoration of sinus rhythm, LA structural and functional parameters significantly improved, and 75 patients (54%) had normal LA volume. During a median follow-up of 44 (31-61) months, 32 patients (23%) experienced a late recurrence of AF (AF recurrence >1 year). Patients who achieved normal LA volume after AF ablation had fewer late recurrences than those who did not (P < .01). However, LA abnormalities, especially LA dysfunction, persisted in AF patients even when the LA volume was normalized compared with controls. CONCLUSION Patients who achieved normal LA volume had better long-term outcomes of AF ablation than those who did not; however, LA abnormalities persisted even after successful ablation of AF.
Collapse
Affiliation(s)
- Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Akira Fujii
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Yasuhiro Sasaki
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Yukari Shikano
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Namiko Sakuoka
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Maki Miyazaki
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Yasunori Takasuka
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| |
Collapse
|
2
|
Avesani M, Degrelle B, Di Salvo G, Thambo JB, Iriart X. Vector flow mapping: A review from theory to practice. Echocardiography 2021; 38:1405-1413. [PMID: 34259359 DOI: 10.1111/echo.15154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The interest in intra-cardiac blood flow analysis is rapidly growing, and it has encouraged the development of different non-invasive imaging techniques. Among these, Vector Flow Mapping (VFM), combing Color-Doppler imaging and speckle tracking data, seems to be a promising approach, feasible in adult and children population. AIM OF THE REVIEW The aim of this review is to give a historical perspective on the development of VFM method and a summary of the current algorithms and parameters potentially evaluable. Then, we will present the current state-of-the-art of VFM with an overview of clinical studies and applications of this technique.
Collapse
Affiliation(s)
- Martina Avesani
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Bastien Degrelle
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France
| | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
| |
Collapse
|
3
|
Ren JF, Chen S, Callans DJ, Liu Q, Supple G, Frankel DS, Santangeli P, Jiang R, Lin D, Hyman M, Yu L, Riley M, Sun Y, Zhang Z, Yu C, Schaller RD, Dixit S, Wang B, Jiang C, Marchlinski FE. ICE-Derived Left Atrial and Left Ventricular Endocardial and Myocardial Speckle Tracking Strain Patterns in Atrial Fibrillation at the Time of Radiofrequency Ablation. J Atr Fibrillation 2021; 13:2509. [PMID: 34950343 PMCID: PMC8691347 DOI: 10.4022/jafib.2509] [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: 01/25/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/10/2022]
Abstract
Objectives Intracardiac echocardiography(ICE) has excellent imaging resolution and border recognition which increase strain measurement accuracy. We hypothesized that left atrial(LA) substrate and functional impairment can be detected by measuring LA strain deformation in patients with persistent and paroxysmal atrial fibrillation(AF), as compared to those with no AF. Strain deformation changes in LA and left ventricle(LV) can also be assessed post-ablation to determine its effect. Methods ICE-derived speckle tracking strain(STS) was prospectively performed in 96 patients, including 62 patients with AF(31 persistent and 31 paroxysmal AF) pre-/post-ablation, and 34 patients with no AF. We measured major strain parameters including longitudinal segmental(endo/myocardial) "average peak overall strain of all segments"(PkAll), peak strain rate(SR),and different time-to-peak strain in LA and LV images. Results At baseline, persistent AF patients had significantly lower(p<0.01) LA endocardial(4.3±2.5 vs. 20.3±8.9 and 25.5±12.9 %) and myocardial PkAll(4.4±2.6 vs. 15.7±7.2 and 20.9±9.2 %), endocardial(0.9±0.4 vs. 1.8±0.7 and 2.2±0.6 1/s) and myocardial peak SR(0.7±0.4 vs. 1.5±0.6 and 1.9±0.5 1/s), as compared to paroxysmal AF and no AF patients. After successful ablation, endo-/myocardial LA PkAll and peak SR were significantly improved, most dramatically in patients with persistent AF. LV endocardial/myocardial strain and SR also improved in AF patients post-ablation. Conclusion LA longitudinal strain(%)/SR(1/s) parameters in AF patients are more abnormal than those with no AF, suggesting LA substrate/functional damage. AF ablation improved LA strains/SR but with values in paroxysmal > persistent AF suggesting background LA damage in persistent AF.
Collapse
Affiliation(s)
- Jian-Fang Ren
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Shiquan Chen
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - David J Callans
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Gregory Supple
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - David S Frankel
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - David Lin
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Matthew Hyman
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Lu Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Michael Riley
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zuwen Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chan Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Robert D Schaller
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Sanjay Dixit
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Bei Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Francis E Marchlinski
- Cardiac Electrophysiology Laboratory, Cardiovascular Medicine Division, University of Pennsylvania Health System, Philadelphia, PA, USA
| |
Collapse
|
4
|
Thromboembolic Risk of Cessation of Oral Anticoagulation Post Catheter Ablation in Patients With and Without Atrial Fibrillation Recurrence. Am J Cardiol 2020; 137:55-62. [PMID: 33002462 DOI: 10.1016/j.amjcard.2020.09.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022]
Abstract
Cessation of oral anticoagulation (OAC) is common after the first 3 months of catheter ablation of atrial fibrillation (AF); however, thromboembolic risk has not been defined in patients with and without AF recurrence (RAF vs NRAF) post ablation. We identified 796 patients who discontinued OAC at 3 months post AF ablation from January 2015 to May 2018 in our center. Regular follow-up was performed to detect RAF, collect medication management and thromboembolic and major bleeding events. CHA2DS2-VASc score was 1.79 ± 1.50; 547 (68.7%) patients were at intermediate and high risk (i.e., CHA2DS2-VASc score ≥1 in male patients, or ≥2 in female patients); 169 (21.2%) were RAF. During 29.2±12.2 months follow-up, the incidence rate of thromboembolism was 1.62 per 100 patient-year (7 in 431 years) in RAF, 0.33 per 100 patient-year (5 in 1,503 years) in NRAF. After adjusting for potential confounding factors, RAF was associated with more 3.5-fold higher rate of thromboembolism compared with NRAF (adjusting HR, 4.488; 95% CI, 1.381 to 14.586). Rate of thromboembolism was even higher in patients with intermediate and high risk (2.16 per 100 patient-year [7 in 323 years] vs 0.38 per 100 patient-year [4 in 1,043 years], aHR, 5.807; 95% CI, 1.631 to 20.671). In multivariate logistic regression analysis, RAF was the only independent predictor of thromboembolism (4.837 [1.498 to 15.621], p = 0.008). In conclusion, cessation of OAC in NRAF may be reasonable, especially for patients with the contraindications for continuing OAC; however, cessation of OAC appeared unsafe in RAF with a high-risk stroke profile because of high incidence rate of thromboembolism.
Collapse
|