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Inciardi RM, Bonelli A, Biering-Sorensen T, Cameli M, Pagnesi M, Lombardi CM, Solomon SD, Metra M. Left atrial disease and left atrial reverse remodeling across different stages of heart failure development and progression: a new target for prevention and treatment. Eur J Heart Fail 2022; 24:959-975. [PMID: 35598167 PMCID: PMC9542359 DOI: 10.1002/ejhf.2562] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
The left atrium is a dynamic chamber with peculiar characteristics. Stressors and disease mechanisms may deeply modify its structure and function, leading to left atrial remodelling and disease. Left atrial disease is a predictor of poor outcomes. It may be a consequence of left ventricular systolic and diastolic dysfunction and neurohormonal and inflammatory activation and/or actively contribute to the progression and clinical course of heart failure through multiple mechanisms such as left ventricular filling and development of atrial fibrillation and subsequent embolic events. There is growing evidence that therapy may improve left atrial function and reverse left atrial remodelling. Whether this translates into changes in patient's prognosis is still unknown. In this review we report current data about changes in left atrial size and function across different stages of development and progression of heart failure. At each stage, drug therapies, lifestyle interventions and procedures have been associated with improvement in left atrial structure and function, namely a reduction in left atrial volume and/or an improvement in left atrial strain function, a process that can be defined as left atrial reverse remodelling and, in some cases, this has been associated with improvement in clinical outcomes. Further evidence is still needed mainly with respect of the possible role of left atrial reverse remodelling as an independent mechanism affecting the patient's clinical course and as regards better standardization of clinically meaningful changes in left atrial measurements. Summarizing current evidence, this review may be the basis for further studies.
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Affiliation(s)
- Riccardo M Inciardi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Bonelli
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Tor Biering-Sorensen
- Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Pagnesi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Scott D Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marco Metra
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Bhat A, Chen HHL, Khanna S, Gan GCH, Abhayaratna WP, Nunes MCP, MacIntyre CR, Tan TC. Clinical and cardiac structural predictors of atrial fibrillation persistence. Eur J Clin Invest 2021; 51:e13395. [PMID: 32886806 DOI: 10.1111/eci.13395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022]
Abstract
AIMS The persistence of atrial fibrillation (AF) has been associated with differential clinical outcomes, with studies showing that persistent and permanent AF results in increased morbidity and mortality when compared to the paroxysmal subtype. Given the established prognostic implications of AF subtype, we sought to discern the clinical and structural cardiac parameters associated with persistent/ permanent AF. MATERIALS AND METHODS Consecutive patients admitted to our institution between January 2013 and January 2018 with a primary diagnosis of non-valvular AF who underwent comprehensive transthoracic echocardiography were retrospectively appraised. Assessment of clinical and echocardiographic parameters was undertaken and compared according to AF subtype. RESULTS Of 1010 patients, 665 (mean age 66.8 ± 13.5 years, 53% men) had comprehensive transthoracic echocardiography on index admission and were included in the primary analysis. The majority of patients (n = 468; 70%) had paroxysmal AF while 197 (30%) had persistent/ permanent AF. Multivariable logistic regression analysis showed that heart failure (adjusted OR 3.135; 95% CI 2.099 to 4.682, P < .001), right atrial (RA) area ≥18 cm2 (adjusted OR 2.147; 95% CI 1.413 to 3.261, P < .001) and left atrial emptying fraction (LAEF) ≤34% (adjusted OR 2.959; 95% CI 1.991 to 4.398, P < .001) were independent predictors of persistent /permanent AF. CONCLUSIONS The presence of heart failure, increased RA size and impaired LA function were associated with persistent/ permanent AF. These clinical and cardiac structural risk markers of AF persistence may identify a target population for early intervention to prevent adverse cardiovascular outcomes.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Walter P Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Maria Carmo P Nunes
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Giannopoulos G, Kossyvakis C, Vrachatis D, Aggeli C, Tsitsinakis G, Letsas K, Tsiachris D, Tsoukala S, Efremidis M, Katritsis D, Deftereos S. Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo-LAEF study). J Cardiovasc Electrophysiol 2019; 30:991-998. [PMID: 30938914 DOI: 10.1111/jce.13933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/06/2019] [Accepted: 03/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Isolation of the pulmonary veins (PVI) has become a mainstay in atrial fibrillation (AFib) therapy. Lesions in left atrial tissue lead to scar formation and this may affect left atrial function. METHODS Patients with paroxysmal AFib were randomly assigned in a 1:2 allocation scheme to radiofrequency (RF) ablation or cryoballoon. Real-time three-dimensional echocardiography was performed (under sinus rhythm in all cases) before ablation and at 1 and 3 months to evaluate the left atrial functional indices. The primary outcome measure was change in left atrial ejection fraction (LAEF) at 1 month. RESULTS 120 patients were randomized (80 to cryoballoon, 40 to RF). The absolute change in LAEF at 1 month was 4.0 (Q1-Q3, -0.1to 7.6)% in the cryoballoon group and -0.8 (Q1-Q3, -1.9 to 0.9)% in the RF group (P < 0.001 for the comparison between groups). At 3 months, the corresponding changes were 6.7 (Q1-Q3, 3.4-11.2)% and 0.7 (Q1-Q3, -0.7 to 3.5)%, respectively (P < 0.001). Overall, the rate of patients with lower LAEF at 3 months compared to baseline was 2.5% in the cryoballoon group and 32.5% in the RF group (P < 0.001). AFib recurrence rate at 6 months was higher in patients with decreased LAEF (odds ratio, 6.2; 95% confidence interval, 2.0-19.5; P = 0.002). CONCLUSION The Cryo-LAEF study prospectively compared the effects of RF and cryoballoon ablation on left atrial function. Both at 1 and 3 months postablation, LAEF was either improved or stable in both ablation groups.
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Affiliation(s)
| | | | - Dimitrios Vrachatis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Constadina Aggeli
- 1st Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsitsinakis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | | | - Styliani Tsoukala
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Michalis Efremidis
- 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | | | - Spyridon Deftereos
- 1st Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Yang CH, Wu VCC, Hung KC, Lin FC. Early Detection of Left Ventricular Diverticulum by Transthoracic Echocardiography. J Med Ultrasound 2017; 25:232-234. [PMID: 30065498 PMCID: PMC6029325 DOI: 10.1016/j.jmu.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/15/2017] [Indexed: 01/15/2023] Open
Abstract
Left ventricular diverticulum is a very rare entity to be found in adults. Noninvasive echocardiography can offer useful information prior to contrast-enhanced computer tomography or invasive angiography. We evaluated a patient with left ventricular apical diverticulum but complained no symptoms. Transthoracic echocardiography demonstrated a outpouching at left ventricle apex. A 640-slice computed tomography later confirmed the left ventricular diverticulum.
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Affiliation(s)
- Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fen-Chiung Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Correspondence to: Fen-Chiung Lin, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan. Fax: +886 3 3281451. E-mail address: (F.-C. Lin)
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Jazayeri MA, Vanga SR, Vuddanda V, Turagam M, Parikh V, Lavu M, Bommana S, Atkins D, Nath J, Rosamond T, Vacek J, Madhu Reddy Y, Lakkireddy D. Impact of Radiofrequency Ablation of Atrial Fibrillation on Pulmonary Vein Cross Sectional Area: Implications for the Diagnosis of Pulmonary Vein Stenosis. J Atr Fibrillation 2017; 10:1531. [PMID: 29250220 DOI: 10.4022/jafib.1531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/19/2017] [Accepted: 06/14/2017] [Indexed: 11/10/2022]
Abstract
Introduction Restoration of normal sinus rhythm by radiofrequency ablation (RFA) in atrial fibrillation (AF) patients can result in a reduction of left atrial (LA) volume and pulmonary vein (PV) dimensions. It is not clear if this PV size reduction represents a secondary effect of overall LA volume reduction or true PV stenosis. We assessed the relationship between LA volume reduction and PV orifice area pre- and post-RFA. Methods A retrospective cohort study was conducted at a tertiary care academic hospital. Pre- and post-RFA cardiac computed tomography (CT) studies of 100 consecutive AF patients were reviewed. Studies identifying obvious segmental PV narrowing were excluded. Left atrial volumes and PV orifice cross-sectional areas (PVOCA) were measured using proprietary software from the CT scanner vendor (GE Healthcare, Waukesha, WI). Results The cohort had a mean age of 60 ± 8 years, 73% were male, and 90% were Caucasian. Non-paroxysmal AF was present in 76% of patients with a mean duration from diagnosis to RFA of 55 ± 54 months. Mean procedural time was 244 ± 70 min. AF recurred in 27% at 3 month follow-up. Pre-RFA LA volumes were 132 ± 60 ml and mean PVOCA was 2.89 ± 2.32 cm2. In patients with successful ablation, mean LA volume decreased by 10% and PVOCA decreased by 21%. PVOCA was significantly reduced in patients with successful RFA compared to those who had recurrence (2.18 ± 1.12 vs. 2.8 ± 1.9 cm2, p = 0.04) but reduction in LA volume between groups was not significant (118 ± 42 vs. 133 ± 54 ml, p=0.15). Conclusions The study demonstrates that both PV orifice dimensions and LA volume are reduced after successful AF ablation. These data warrant a reassessment of criteria for diagnosing PV stenosis based on changes in PV caliber alone, ideally incorporating LA volume changes.
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Affiliation(s)
- Mohammad-Ali Jazayeri
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Subba Reddy Vanga
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Venkat Vuddanda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Mohit Turagam
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Valay Parikh
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Madhav Lavu
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Sudharani Bommana
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Jayant Nath
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Thomas Rosamond
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - James Vacek
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Y Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
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Left Atrial Reverse Remodeling. JACC Cardiovasc Imaging 2017; 10:65-77. [DOI: 10.1016/j.jcmg.2016.11.003] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 12/12/2022]
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Yang CH, Chou CC, Hung KC, Wen MS, Chang PC, Wo HT, Lee CH, Lin FC. Comparisons of the underlying mechanisms of left atrial remodeling after repeat circumferential pulmonary vein isolation with or without additional left atrial linear ablation in patients with recurrent atrial fibrillation. Int J Cardiol 2016; 228:449-455. [PMID: 27870975 DOI: 10.1016/j.ijcard.2016.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) is a potentially curative treatment for atrial fibrillation (AF), however, whether or not additional left atrial (LA) linear ablation for recurrent AF adversely affects LA remodeling is unknown. METHODS Thirty-eight patients experiencing AF recurrence after the 1st circumferential pulmonary vein isolation (CPVI) underwent a repeat RFCA, including 20 and 18 patients receiving a repeat CPVI (group I) or CPVI plus LA linear ablation (group II), respectively. 2-D echocardiography was performed during sinus rhythm within 24h, at 1-m and 6-m after RFCA. Longitudinal strains and strain rate were measured with speckle-tracking echocardiography. The standard deviation of contraction duration was defined as LA mechanical dispersion. RESULTS One and two patients experienced AF recurrence after the 2nd RFCA in group I and II, respectively (P=NS). The 1st CPVI with AF recurrence did not reduce LA size significantly in two groups. After a repeat CPVI, LA diameter but not LA maximal and minimal volume was significantly reduced in group I; additional LA linear ablation significantly decreased LA diameter, maximal and minimal volume in group II. However, there was no significant difference in LA emptying function, global and segmental LA strain and strain rate among the baseline, 1-m and 6-m follow-up in two groups. RFCA did not significantly increase LA mechanical dispersion regardless of the AF ablation strategies. CONCLUSIONS In patients with recurrent AF, a successful repeat CPVI with or without additional LA linear ablation reduced LA size without significant deleterious effects on LA function and mechanical dispersion.
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Affiliation(s)
- Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-Ta Wo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fen-Chiung Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Sanchis L, Prat S, Sitges M. Cardiovascular Imaging in the Electrophysiology Laboratory. ACTA ACUST UNITED AC 2016; 69:595-605. [PMID: 27107802 DOI: 10.1016/j.rec.2016.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/09/2016] [Indexed: 10/21/2022]
Abstract
In recent years, rapid technological advances have allowed the development of new electrophysiological procedures that would not have been possible without the parallel development of imaging techniques used to plan and guide these procedures and monitor their outcomes. Ablation of atrial fibrillation is among the interventions with the greatest need for imaging support. Echocardiography allows the appropriate selection of patients and the detection of thrombi that would contraindicate the intervention; cardiac magnetic resonance imaging and computed tomography are also essential in planning this procedure, by allowing a detailed anatomical study of the pulmonary veins. In addition, in cardiac resynchronization therapy, echocardiography plays a central role in both patient selection and, later, in device adjustment and in assessing the effectiveness of the technique. More recently, ablation of ventricular tachycardias has been established as a treatment option; this would not be possible without planning using an imaging study such as cardiac magnetic resonance imaging of myocardial scarring.
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Affiliation(s)
- Laura Sanchis
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Susanna Prat
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marta Sitges
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Lee A, See VA, Lim TW, Descallar J, Chik W, Ross DL, Thomas SP, Thomas L. Atrial fibrillation ablation by single ring isolation versus wide antral isolation: Effects on left atrial size and function. Int J Cardiol 2015; 206:1-6. [PMID: 26761395 DOI: 10.1016/j.ijcard.2015.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/06/2015] [Accepted: 12/12/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) by single ring isolation (SRI) has been demonstrated to reduce recurrence of atrial fibrillation (AF) compared to the standard technique of wide antral isolation (WAI). In this study, we examine the differential effect of these techniques on left atrial size and function. METHODS We examined left atrial (LA) size (LA maximum and LA minimum volumes) and function (LA emptying fraction and LA expansion index) over a period of 6 months following PVI as measured by transthoracic echocardiography in 187 patients that were enrolled in a randomised controlled trial of SRI vs WAI. RESULTS Compared to pre-ablation, at 6 months post-PVI, there was a small decrease in the LA maximum volume in the WAI group (67.3 vs 62.7 mL, p=0.02). The LA size did not change significantly over 6 months in the SRI group. Patients who underwent SRI had a small reduction in the LA expansion index at 6 months post-PVI compared to baseline (80.6 vs 66.6%, p=0.02). LA function did not change significantly over 6 months in the WAI group. However, at 6 months, there was no difference in any measure of LA size or function between the SRI and WAI groups. CONCLUSIONS SRI, whilst previously demonstrated to be more effective than WAI in preventing AF recurrence, is associated with minimal adverse effects on left atrial function at medium term follow-up despite the isolation of a larger region of LA myocardium.
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Affiliation(s)
- Adam Lee
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | - Valerie A See
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | - Toon Wei Lim
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Cardiac Department, National University Heart Centre, Singapore
| | - Joseph Descallar
- Ingham Institute, Sydney, Australia; The University of New South Wales, Sydney, Australia
| | - William Chik
- Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - David L Ross
- Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Liza Thomas
- Department of Cardiology, Liverpool Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia; The University of Sydney, Sydney, Australia.
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Grandío PC, Bisbal F. Current Role And Future Prospects Of Magnetic Resonance Imaging In The Field Of Atrial Fibrillation Ablation. J Atr Fibrillation 2015; 8:1281. [PMID: 27957210 DOI: 10.4022/jafib.1281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and catheter ablation of AF has become a first-line treatment for symptomatic drug-refractory AF. However, this is a complex procedure and recurrences after a single ablation procedure are frequent. New technologies are needed to simplify the procedure and improve results, and cardiac magnetic resonance (CMR) has emerged as a useful tool to stratify the risk of recurrence, guide the ablation procedure, and monitor the post-ablation remodeling process. This review summarizes the current role of CMR in the field of AF ablation and offers a perspective on its future potential.
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Xiong B, Li D, Wang J, Gyawali L, Jing J, Su L. The Effect of Catheter Ablation on Left Atrial Size and Function for Patients with Atrial Fibrillation: An Updated Meta-Analysis. PLoS One 2015; 10:e0129274. [PMID: 26147984 PMCID: PMC4493108 DOI: 10.1371/journal.pone.0129274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 05/06/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Catheter ablation (CA) for atrial fibrillation (AF) is now an important therapeutic modality for patients with AF. However, data regarding changes in left atrial (LA) function after CA have indicated conflicting results depending on the AF types, follow-up period, and the analytical imaging tools. The objective of this review was to analyze the effect of CA on the LA size and function for patients with AF. METHODS We searched for studies regarding LA size and function pre- and post-ablation in PubMed, Embase, the Cochrane Library, and Web of Knowledge through May 2014. LA function was measured by LA ejective fraction (LAEF), LA active ejective fraction (LAAEF), or both. Total and subgroup analyses were implemented using Cochrane Review Manager Version 5.2. Weighted mean differences with 95% confidence intervals were used to express the results of continuous outcomes using fixed or random effect models. I2 was used to calculate heterogeneity. To assess publication bias, Egger's test and Begg's funnel plot were performed using Stata 12.0. RESULTS Twenty-five studies (2040 enrolled patients) were selected for this meta-analysis. The LA diameter (LAD), maximum LA volume, and minimal LA volume were significantly decreased post-ablation, as compared with those at a pre-ablation visit. Compared with the pre-ablation outcomes, we found no significant differences in LAEF/LAAEF at a post-ablation follow-up. Decreases in LA volume and LAEF remained significant post-ablation for paroxysmal AF (PAF); however, the LAEF was insignificant changes in persistent AF (PeAF). Heterogeneity was significant in spite which individual study was excluded. A publication bias was not found. In a meta-regression analysis, we did not find any factor that contributed to the heterogeneity. CONCLUSION With CA, LA volumes and LAD were decreased significantly in patients with AF; LAEF was not significant changes in patients with PeAF but decreased in those with PAF.
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Affiliation(s)
- Bin Xiong
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing, China
| | - Dan Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing, China
| | - Jianling Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing, China
| | - Laxman Gyawali
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing, China
| | - Jinjin Jing
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing, China
| | - Li Su
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, The Chongqing Cardiac Arrhythmias Service Center, Chongqing, China
- * E-mail:
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Inoue YY, Alissa A, Khurram IM, Fukumoto K, Habibi M, Venkatesh BA, Zimmerman SL, Nazarian S, Berger RD, Calkins H, Lima JA, Ashikaga H. Quantitative tissue-tracking cardiac magnetic resonance (CMR) of left atrial deformation and the risk of stroke in patients with atrial fibrillation. J Am Heart Assoc 2015; 4:jah3941. [PMID: 25917441 PMCID: PMC4579945 DOI: 10.1161/jaha.115.001844] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent evidence suggests that left atrial (LA) dysfunction may be mechanistically contributing to cerebrovascular events in patients with atrial fibrillation (AF). We investigated the association between regional LA function and a prior history of stroke during sinus rhythm in patients referred for catheter ablation of AF. METHODS AND RESULTS A total of 169 patients (59 ± 10 years, 74% male, 29% persistent AF) with a history of AF in sinus rhythm at the time of pre-ablation cardiac magnetic resonance (CMR) were analyzed. The LA volume, emptying fraction, strain (S), and strain rate (SR) were assessed by tissue-tracking cardiac magnetic resonance. The patients with a history of stroke or transient ischemic attack (n=18) had greater LA volumes (Vmax and Vmin; P=0.02 and P<0.001, respectively), lower LA total emptying fraction (P<0.001), lower LA maximum and pre-atrial contraction strains (Smax and SpreA; P<0.001 and P=0.01, respectively), and lower absolute values of LA SR during left ventricular (LV) systole and early diastole (SRs and SRe; P=0.005 and 0.03, respectively) than those without stroke/transient ischemic attack (n=151). Multivariable analysis demonstrated that the LA reservoir function, including total emptying fraction, Smax, and SRs, was associated with stroke/transient ischemic attack (odds ratio 0.94, 0.91, and 0.17; P=0.03, 0.02, and 0.04, respectively) after adjusting for the CHA2DS2-VASc score and LA Vmin. CONCLUSIONS Depressed LA reservoir function assessed by tissue-tracking cardiac magnetic resonance is significantly associated with a prior history of stroke/transient ischemic attack in patients with AF. Our findings suggest that assessment of LA reservoir function can improve the risk stratification of cerebrovascular events in AF patients.
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Affiliation(s)
- Yuko Y. Inoue
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
| | - Abdullah Alissa
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
| | - Irfan M. Khurram
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
| | - Kotaro Fukumoto
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
| | - Mohammadali Habibi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
| | - Bharath A. Venkatesh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (B.A.V., S.L.Z.)
| | - Stefan L. Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (B.A.V., S.L.Z.)
| | - Saman Nazarian
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD (S.N.)
| | - Ronald D. Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD (R.D.B., H.A.)
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
| | - Joao A. Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
| | - Hiroshi Ashikaga
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.)
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD (R.D.B., H.A.)
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Santos SND, Henz BD, Zanatta AR, Barreto JR, Loureiro KB, Novakoski C, Santos MVND, Giuseppin FF, Oliveira EM, Leite LR. Impact of atrial fibrillation ablation on left ventricular filling pressure and left atrial remodeling. Arq Bras Cardiol 2015; 103:485-92. [PMID: 25590928 PMCID: PMC4290739 DOI: 10.5935/abc.20140152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/31/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. OBJECTIVE To evaluate the impact of AF ablation on estimated LV filling pressure. METHODS A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. RESULTS One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m(2) ± 10.6 mL/m(2) to 22.6 mL/m(2) ± 1.1 mL/m(2), p < 0.001) compared to the non-successful group (37.7 mL/m(2) ± 14.3 mL/m(2) to 37.5 mL/m(2) ± 14.5 mL/m(2), p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). CONCLUSION Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.
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Affiliation(s)
| | - Benhur Davi Henz
- Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil
| | | | | | | | | | | | - Fabio F Giuseppin
- Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil
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15
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Mamchur S, Mamchur I, Khomenko E, Kokov A, Bokhan N, Sherbinina D. Mechanical function of left atrium and pulmonary vein sleeves before and after their antrum isolation. MEDICINA-LITHUANIA 2014; 50:353-9. [PMID: 25541269 DOI: 10.1016/j.medici.2014.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary vein (PV) sleeves are established as the main substrate taking part in the mechanisms of atrial fibrillation (AF) initiation. However, we have extremely few data concerning their physiological role in the heart contractility. The aim of the study was to estimate the mechanical function of the left atrium (LA) and PV sleeves before and early after their isolation. MATERIALS AND METHODS A total of 17 patients with a mean age of 57.4±8.3 years who underwent PVs isolation due to AF were enrolled in the study. A day before the procedure a computed tomography (CT) of the LA and PVs and dopplerography of transmitral flow were performed. During the procedure the mechanical function of the LA and PV sleeves were estimated by transesophageal echocardiography and manometry in the left heart chambers. RESULTS During the invasive study the patterns of the heart chambers and PV sleeves pressure were identified. These patterns confirmed the active role of the PV sleeves in LA filling and active LA relaxation during left ventricular systole. After PV isolation an alteration of transmitral blood flow and increase of LA pressure were registered. However, diastolic dysfunction was ruled out by LV manometry, thereby testifying LA mechanical function disturbance. The change in PV hemodynamics also occurred as a result of the decrease in PV sleeves contractility, revealed by manometry and paired CT scans. CONCLUSIONS The PVs take an active part in left atrial filling by contraction of their sleeves. Antrum isolation of the PVs leads to the deterioration of their contractility and LA reservoir function.
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Affiliation(s)
- Sergey Mamchur
- Department of Arrhythmology and Pacing, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.
| | - Irina Mamchur
- Department of Arrhythmology and Pacing, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - Egor Khomenko
- Department of Arrhythmology and Pacing, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - Alexander Kokov
- Department of Arrhythmology and Pacing, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - Nikita Bokhan
- Department of Arrhythmology and Pacing, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - Diana Sherbinina
- Department of Arrhythmology and Pacing, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
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Tang RB, Yan XL, Dong JZ, Kalifa J, Long DY, Yu RH, Bai R, Kang JP, Wu JH, Sang CH, Ning M, Jiang CX, Salim M, Ma CS. Predictors of recurrence after a repeat ablation procedure for paroxysmal atrial fibrillation: role of left atrial enlargement. Europace 2014; 16:1569-1574. [DOI: 10.1093/europace/euu013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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17
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Sanchis L, Gabrielli L, Andrea R, Falces C, Duchateau N, Perez-Villa F, Bijnens B, Sitges M. Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2014; 16:62-7. [PMID: 25187609 DOI: 10.1093/ehjci/jeu165] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS Pathophysiology of heart failure (HF) with preserved ejection fraction (HFPEF) remains unclear. Left atrial (LA) function has been related to HF symptoms. Our purpose is to analyse LA function in outpatients with new onset symptoms of HF. METHODS AND RESULTS An observational study was performed including 138 consecutive outpatients with suspected HF referred to a one-stop clinic. Final diagnosis [HF with reduced EF (HFREF), HFPEF, or non-HF] was established according to current recommendations. Echocardiography was performed in all patients. LA function was analysed using strain derived from speckle tracking in sinus rhythm patients (n = 83). Results were analysed with ANOVA and Bonferroni statistical tests. Receiver operating characteristic (ROC) curves were constructed to investigate the predictive ability of LA parameters for the final diagnosis of HF. Patients were 75 ± 9 years and 63% women. Final diagnosis was 23.2% HFREF, 45.7% HFPEF, and 31.2% non-HF. Left ventricular strain rate showed no differences between non-HF and HFPEF groups, but both groups showed differences with the HFREF group. LA strain rate (A- and S-waves) was significantly reduced in both HF groups (without differences among them) when compared with the non-HF group. LA strain rate and indexed volume showed significant accuracy for HF diagnosis in ROC curves. CONCLUSIONS In outpatients with new-onset symptoms of HF, LA dysfunction was observed. It might be the initial mechanism in the development of symptoms in HFPEF patients. These findings support the relationship of LA dysfunction with HFPEF, suggesting that the analysis of LA function may be useful in sinus rhythm patients with new-onset dyspnoea.
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Affiliation(s)
- Laura Sanchis
- Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Luigi Gabrielli
- Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain Cardiovascular Disease Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rut Andrea
- Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Carles Falces
- Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Nicolas Duchateau
- Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Felix Perez-Villa
- Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Bart Bijnens
- ICREA-Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
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18
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Zhuang Y, Yong YH, Chen ML. Updating the evidence for the effect of radiofrequency catheter ablation on left atrial volume and function in patients with atrial fibrillation: a meta-analysis. JRSM Open 2014; 5:2054270414521185. [PMID: 25057380 PMCID: PMC4012673 DOI: 10.1177/2054270414521185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To systematically review the effects of radiofrequency catheter ablation (RFCA) on left atrial (LA) size, volumes and function in patients with atrial fibrillation (AF). Methods We searched MEDLINE, EMBASE, ScienceDirect, Highwire, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the reference lists of retrieved reports in July 2012. Setting China Participants Twenty-six studies (enrolling 1821 patients) were included in the final analysis. Main outcome measures Changes of LA size or volumes and/or function in patients with AF after RFCA. Results Compared to pre-ablation values, there were significant decreases in LA diameter and LA volumes at post-ablation follow-up. However, compared to pre-ablation values, there were no significant differences in LA ejection fraction/LA active emptying fraction and LA strain at post-ablation follow-up. Decreases in LA diameter and LA volumes remained significant in those without AF recurrence but not in those with AF recurrence. LA ejection fraction/LA active emptying fraction did not decrease in patients without AF recurrence, whereas they decreased in patients with AF recurrence. As for LA strain, it seems that LA strain increases in patients without AF recurrence, with less fibrosis and with more LA volumes decrease, but the differences were not significant. Conclusions Successful RFCA in patients with AF significantly decreases LA size and volumes and does not seem to adversely affect LA function.
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Affiliation(s)
- Yan Zhuang
- Intensive Care Unit, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China
| | - Yong-Hong Yong
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ming-Long Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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19
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Bisbal F, Guiu E, Cabanas P, Calvo N, Berruezo A, Tolosana JM, Arbelo E, Vidal B, de Caralt TM, Sitges M, Brugada J, Mont L. Reversal of spherical remodelling of the left atrium after pulmonary vein isolation: incidence and predictors. Europace 2014; 16:840-7. [DOI: 10.1093/europace/eut385] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Hof IE, Vonken EJ, Velthuis BK, Wittkampf FH, van der Heijden JF, Neven KG, Kassenberg W, Meine M, Cramer MJ, Hauer RN, Loh P. Impact of pulmonary vein antrum isolation on left atrial size and function in patients with atrial fibrillation. J Interv Card Electrophysiol 2013; 39:201-9. [PMID: 24317918 DOI: 10.1007/s10840-013-9860-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The success of PVAI in eliminating AF has been proven; however, its impact on the LA remains uncertain. This study aimed to determine the impact of pulmonary vein antrum isolation (PVAI) on left atrial (LA) size and function in patients with atrial fibrillation (AF). METHODS Consecutive patients with AF were included (n = 206). Magnetic resonance imaging (MRI) was performed before and after PVAI in all patients. A subgroup (n = 52) underwent delayed enhancement MRI. Maximal LA volume (LAVmax) and minimal LA volume (LAVmin) were assessed by Simpson's rule. LA function was determined by calculating LA ejection fraction (LA EF). LA fibrosis was manually encircled and summed in the region of interest. RESULTS Single procedure success rate was 64 %. LAVmax decreased post-ablation in all patients (125.1 to 111.9 ml, p < 0.001). LAVmin only decreased in patients with a successful outcome post-ablation (65.6 to 58.8 ml, p < 0.001). As a result, LA EF only showed a marked reduction in patients with AF recurrences (42.7 % to 37.9 %, p < 0.001). Post-ablation LA fibrosis could be visualized in 77 % of patients who underwent delayed enhancement MRI (mean amount 1.4 cm(3)). LA fibrosis showed no correlation with the decrease in LAVmax or LA EF. CONCLUSIONS PVAI resulted in a reduction of LAVmax in all patients, indicating an effect of ablation induced fibrosis. LAVmin only decreased in patients with a successful outcome, indicating an effect of reverse atrial remodeling. As a result, LA function post-ablation was preserved in patients with a successful outcome and decreased in patients with AF recurrence.
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Affiliation(s)
- Irene E Hof
- Department of Cardiology, E03.511, University Medical Center, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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21
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Moyer CB, Helm PA, Clarke CJ, Budge LP, Kramer CM, Ferguson JD, Norton PT, Holmes JW. Wall-motion based analysis of global and regional left atrial mechanics. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:1765-1776. [PMID: 23708788 PMCID: PMC4427253 DOI: 10.1109/tmi.2013.2264062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Atrial fibrillation is an increasingly prevalent cardiovascular disease; changes in atrial structure and function induced by atrial fibrillation and its treatments are often spatially heterogeneous. However, spatial heterogeneity of function is difficult to assess with standard imaging techniques. This paper describes a method to assess global and regional mechanical function by combining cardiac magnetic resonance imaging and finite-element surface fitting. We used this fitted surface to derive measures of left atrial volume, regional motion, and spatial heterogeneity of motion in 23 subjects, including healthy volunteers and atrial fibrillation patients. We fit the surfaces using a Newton optimization scheme in under 1 min on a standard laptop, with a root mean square error of 2.3 ± 0.5 mm, less than 9% of the mean fitted radius, and an inter-operator variability of less than 10%. Fitted surfaces showed clear definition of the phases of left atrial motion (filling, passive emptying, active contraction) in both volume-time and regional radius-time curves. Averaged surfaces of healthy volunteers and atrial fibrillation patients provided evidence of substantial regional variation in both amount and timing of regional motion, indicating spatial heterogeneity of function, even in healthy adults.
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22
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JANG SUNGWON, OH YONGSEOG, SHIN WOOSEUNG, UHM JAESUN, KIM SUNGHWAN, KIM JIHOON, LEE MANYOUNG, RHO TAIHO. Impact of Left Anterior Line on Left Atrial Appendage Contractility in Patients Who Underwent Catheter Ablation for Chronic Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:179-87. [DOI: 10.1111/pace.12241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 06/14/2013] [Accepted: 06/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- SUNG-WON JANG
- Division of Cardiology, Department of Internal Medicine; The Catholic University of Korea; Seoul Republic of Korea
| | - YONG-SEOG OH
- Division of Cardiology, Department of Internal Medicine; The Catholic University of Korea; Seoul Republic of Korea
| | - WOO-SEUNG SHIN
- Division of Cardiology, Department of Internal Medicine; The Catholic University of Korea; Seoul Republic of Korea
| | - JAE SUN UHM
- Yonsei University Health System; Seoul Republic of Korea
| | - SUNG-HWAN KIM
- Division of Cardiology, Department of Internal Medicine; The Catholic University of Korea; Seoul Republic of Korea
| | - JI-HOON KIM
- Division of Cardiology, Department of Internal Medicine; The Catholic University of Korea; Seoul Republic of Korea
| | - MAN-YOUNG LEE
- Division of Cardiology, Department of Internal Medicine; The Catholic University of Korea; Seoul Republic of Korea
| | - TAI-HO RHO
- Division of Cardiology, Department of Internal Medicine; The Catholic University of Korea; Seoul Republic of Korea
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Aljaroudi WA, Saliba WS, Wazni OM, Jaber WA. Role of cardiac computed tomography and cardiovascular magnetic resonance imaging in guiding management and treatment of patients with atrial fibrillation: state of the art review. J Nucl Cardiol 2013; 20:426-42. [PMID: 23400559 DOI: 10.1007/s12350-013-9689-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/28/2013] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with high morbidity and mortality. In view of an aging population, the prevalence and incidence of AF are on the rise and are expected to double in the coming decades, posing a huge economic burden on already strained resources. New innovative therapies such as pulmonary vein isolation and percutaneous closure of the left atrial appendage have emerged. The current applications of such therapies would not have been possible without the pivotal role of multimodality cardiovascular imaging. The role of echocardiography in guiding therapy has been extensively reviewed. However, there are new data in support of other complementary imaging modalities, mainly cardiac computed tomography and cardiovascular magnetic resonance imaging, which will be the focus of this review.
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Affiliation(s)
- Wael A Aljaroudi
- Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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24
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Bisbal F, Guiu E, Calvo N, Marin D, Berruezo A, Arbelo E, Ortiz-Pérez J, de Caralt TM, Tolosana JM, Borràs R, Sitges M, Brugada J, MONT LLUÍS. Left Atrial Sphericity: A New Method to Assess Atrial Remodeling. Impact on the Outcome of Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol 2013; 24:752-9. [DOI: 10.1111/jce.12116] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Felipe Bisbal
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - Esther Guiu
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - Naiara Calvo
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - David Marin
- Mathematics Department, Universitat Autònoma de Barcelona; Catalonia Spain
| | - Antonio Berruezo
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - Elena Arbelo
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - José Ortiz-Pérez
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - Teresa María de Caralt
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - José María Tolosana
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - Roger Borràs
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - Marta Sitges
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - Josep Brugada
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
| | - LLUÍS MONT
- Unitat de Fibril·lació Auricular (UFA); Servei de Cardiologia; Hospital Clínic; Universitat de Barcelona; Catalonia Spain IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer)
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To ACY, Klein AL. Role of Echocardiography in Pulmonary Vein Ablation for Atrial Fibrillation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evaluation of different magnetic resonance imaging techniques for the assessment of active left atrial emptying. Eur Radiol 2012; 22:1904-11. [DOI: 10.1007/s00330-012-2460-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/12/2012] [Accepted: 02/23/2012] [Indexed: 11/30/2022]
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Montserrat S, Sitges M, Calvo N, Silva E, Tamborero D, Vidal B, Berruezo A, Bernado C, Mont L, Brugada J. Effect of repeated radiofrequency catheter ablation on left atrial function for the treatment of atrial fibrillation. Am J Cardiol 2011; 108:1741-6. [PMID: 21906703 DOI: 10.1016/j.amjcard.2011.07.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 11/24/2022]
Abstract
Radiofrequency catheter ablation (RFCA) is a potential curative treatment for atrial fibrillation (AF) by eliminating the arrhythmia and inducing left atrial (LA) reverse remodeling. However, the effect on LA function, especially after repeated procedures, has scarcely been studied. The aim of this study was to evaluate the impact of RFCA on LA size and function in patients with AF after a first and a repeated procedure. RFCA was performed in 154 patients with symptomatic drug-refractory AF. LA volumes and function were assessed with real-time 3-dimensional echocardiography before and 6 months after the procedure. Recurrence of the arrhythmia was defined as any atrial tachyarrhythmia lasting >30 seconds, clinically documented or by 24-hour Holter recording, after the first 6 months after ablation. Of the 154 patients, 104 (67%) required only a first ablation, and 50 (33%) required redo RFCA. LA volume was reduced after first RFCA (from 60 ± 19 to 52 ± 17 ml for 3-dimensional LA maximum volume, p <0.001, and from 38 ± 18 to 33 ± 15 ml for 3-dimensional LA minimum volume, p <0.000) without impairment of LA contractile function, measured as the active emptying percentage of total volume (39 ± 25% vs 43 ± 26%, p = NS). After repeated RFCA procedures, 3-dimensional LA maximum volume was reduced (from 57 ± 18 to 52 ± 18 ml, p = 0.04), also without further LA contractile function impairment (active emptying percentage of total volume) (36 ± 24% vs 36 ± 25% of total volume, p = NS). This effect was similar in paroxysmal and persistent AF. In conclusion, RFCA induces reductions in LA volumes without a deleterious impact on contractile function, even after repeated ablation.
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Clinical Utility of Multimodality LA Imaging. JACC Cardiovasc Imaging 2011; 4:788-98. [DOI: 10.1016/j.jcmg.2011.02.018] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/28/2011] [Accepted: 02/15/2011] [Indexed: 11/23/2022]
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Nakamura K, Funabashi N, Uehara M, Ueda M, Murayama T, Takaoka H, Komuro I. Left atrial wall thickness in paroxysmal atrial fibrillation by multislice-CT is initial marker of structural remodeling and predictor of transition from paroxysmal to chronic form. Int J Cardiol 2011; 148:139-47. [DOI: 10.1016/j.ijcard.2009.10.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 10/18/2009] [Indexed: 10/20/2022]
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Hof IE, Loh P. Left atrial size and function after catheter ablation of atrial fibrillation: comparing apples and oranges. Am J Cardiol 2011; 107:143; author reply 143-4. [PMID: 21146702 DOI: 10.1016/j.amjcard.2010.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/13/2010] [Indexed: 11/25/2022]
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Jeevanantham V, Daubert JP, Fitzgerald D. Reply. Am J Cardiol 2011. [DOI: 10.1016/j.amjcard.2010.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hof IE, Velthuis BK, Chaldoupi SM, Wittkampf FH, van Driel VJ, van der Heijden JF, Cramer MJ, Meine M, Hauer RN, Loh P. Pulmonary vein antrum isolation leads to a significant decrease of left atrial size. Europace 2010; 13:371-5. [PMID: 21186231 DOI: 10.1093/europace/euq464] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIMS Pulmonary vein antrum isolation (PVAI) is an effective treatment for atrial fibrillation (AF); however, its impact on left atrial (LA) size is unknown. This study evaluates the impact of PVAI on LA size, and whether LA size differs between patients with a successful outcome and patients with AF recurrences. METHODS AND RESULTS Seventy-nine patients (76% male, mean age 56 ± 8 years) with symptomatic, drug refractory AF (70% paroxysmal, 30% persistent/permanent) underwent radiofrequency PVAI. Ablation lesions were created encircling right and left pulmonary venous ostia in pairs. The endpoint was complete isolation of all pulmonary veins. Magnetic resonance imaging was performed before and 4 months after PVAI and LA volume was measured by manually tracing the LA area. Clinical follow-up was at 1, 3, 6, 12, and 24 months. Rhythm status was determined by history, electrocardiogram, and 48 h Holter monitoring. After a mean follow-up of 12 ± 5 months, 62 patients (78%) were free of AF (72% without antiarrhythmic drugs). In the total group, LA volume decreased from 104 ± 27 mL to 91 ± 25 mL, P < 0.001. Patients with a successful outcome showed a decrease in LA volume of 103 ± 27 mL to 89 ± 24 mL, P < 0.001. Among patients with AF recurrences, LA volume decreased from 105 ± 29 mL to 95 ± 27 mL, P = 0.012. No significant difference was seen between the change in LA volume in both subgroups, P = 0.27. CONCLUSION Pulmonary vein antrum isolation in patients with AF resulted in a significant decrease of LA size. There was no relation between the decrease in LA size and the recurrence of AF after PVAI.
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Affiliation(s)
- Irene E Hof
- Division of Heart and Lungs, Department of Cardiology, E03.511, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Kataoka A, Funabashi N, Takahashi A, Yajima R, Takahashi M, Uehara M, Takaoka H, Saito M, Yamaguchi C, Lee K, Nomura F, Komuro I. Quantitative evaluation of left atrial volumes and ejection fraction by 320-slice computed-tomography in comparison with three- and two-dimensional echocardiography: a single-center retrospective-study in 22 subjects. Int J Cardiol 2010; 153:47-54. [PMID: 20826014 DOI: 10.1016/j.ijcard.2010.08.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 06/24/2010] [Accepted: 08/07/2010] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate efficacy and reproducibility of 320-slice computed tomography (CT) for measuring left atrial (LA) maximum (LAVmax) and minimum volume (LAVmin) during the cardiac cycle, we compared CT with three- and two-dimensional (3D and 2D) transthoracic echocardiogram (TTE). MATERIALS AND METHODS LAVmax and LAVmin (ml), and LA ejection fraction (LAEF) (%) were assessed in 22 consecutive subjects (15 males, 59.5 ± 15.1 years) using retrospective electrocardiogram gated 320-slice CT (Aquilion One, Toshiba Medical) and 3D-TTE (IE-33, Phillips). LAVmax and LAVmin were selected from the time volume curve. LAEF was calculated as (LAVmax-LAVmin)/LAVmax×100(%). RESULTS Mean ± standard deviation (SD) of LAVmax and LAV min were significantly larger by CT than 3D-TTE or 2D-TTE (both P<0.01). LAEF was 25.3 ± 13.1% by CT, 30.2 ± 6.8% by 3D-TTE (P=NS) and 33.9 ± 8.9% by 2D-TTE (P<0.05). The correlation coefficients (CCs) between CT and 3D-TTE in LAVmax, LAmin, and LAEF were 0.64, 0.68 and 0.57, respectively. Mean difference ± 1.96SD of LAVmax, LAVmin and LAEF by Bland and Altman analysis calculated from CT minus 3D-TTE were 48.8 ± 59.1 ml, 41.1 ± 63.2 ml, and -4.9 ± 21.1%, respectively. The CCs and mean difference ± 1.96SD between CT and 2D-TTE had similar tendencies. The CCs of interobserver variation were (for CT, 3D-TTE, 2D-TTE, respectively): 0.90, 0.95 and 0.94 (LAVmax), 0.97 and 0.97 and 0.93 (LAVmin), and 0.64, 0.77 and 0.34 (LAEF). CONCLUSIONS 320-slice CT enables direct LAV measurements and has high reproducibility and positive correlation with 3D and 2D TTE. Absolute value of LAV by CT was larger than that by 3D and 2D TTE.
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Affiliation(s)
- Akihisa Kataoka
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
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Meta-analysis of the effect of radiofrequency catheter ablation on left atrial size, volumes and function in patients with atrial fibrillation. Am J Cardiol 2010; 105:1317-26. [PMID: 20403486 DOI: 10.1016/j.amjcard.2009.12.046] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 11/24/2022]
Abstract
The effects of radiofrequency catheter ablation (RFCA) on left atrial (LA) size, volumes, and function in patients with atrial fibrillation (AF) are not well understood. The aim of this study was to systematically review the effects of RFCA on LA size, volumes, and function in patients with AF. Medline, the Web of Science, the Cochrane Central Register of Controlled Trials, and the reference lists of retrieved reports were searched for relevant studies through April 2009. Studies conducted in patients with AF were included if their primary outcomes were changes in LA size or volumes and/or function before and after RFCA. Weighted mean differences for changes in LA diameter, LA maximum volume, LA minimum volume, LA ejection fraction, and LA active emptying fraction were estimated using fixed- and random-effects meta-analyses. Seventeen relevant studies (enrolling 869 patients) among 192 identified studies were included in the final analysis. Compared to preablation values, there were significant decreases in LA diameter and LA volumes at postablation follow-up. However, compared to preablation values, there were no significant differences in LA ejection fraction and LA active emptying fraction at postablation follow-up. Decreases in LA diameter and LA volumes remained significant in those without AF recurrence but not in those with AF recurrence. LA ejection fraction and LA active emptying fraction did not decrease in patients without AF recurrence, whereas they decreased in patients with AF recurrence. In conclusion, successful RFCA in patients with AF significantly decreases LA size and volumes and does not seem to adversely affect LA function.
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Hornero F, García-Cosío F, José López Gude M. Cirugía de la taquicardia auricular regular. Mecanismos macrorreentrante y focal. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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TSAO HSUANMING, HU WEICHIH, WU MEIHAN, TAI CHINGTAI, CHANG SHIHLIN, LIN YENNJIANG, LO LIWEI, HUANG CHINCHOU, HU YUFENG, SHEU MINGHUEI, CHANG CHENGYEN, CHEN SHIHANN. The Impact of Catheter Ablation on the Dynamic Function of the Left Atrium in Patients with Atrial Fibrillation: Insights from Four-Dimensional Computed Tomographic Images. J Cardiovasc Electrophysiol 2010; 21:270-7. [DOI: 10.1111/j.1540-8167.2009.01618.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Arya A, Hindricks G, Sommer P, Huo Y, Bollmann A, Gaspar T, Bode K, Husser D, Kottkamp H, Piorkowski C. Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients. Europace 2009; 12:173-80. [PMID: 19889688 DOI: 10.1093/europace/eup331] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Identifying suitable candidates for circumferential left atrial pulmonary vein ablation (CPVA). CPVA is widely used as an ablation strategy in patients with atrial fibrillation (AF). Understanding the predictors of long-term success of single catheter ablation procedure of AF based on CPVA can help to identify those patients who have a high risk of recurrence based on this approach. METHODS AND RESULTS In this retrospective analysis 674 consecutive patients (464 male, mean age 57.3 +/- 10.8 years) with AF (84.8%, paroxysmal) treated with CPVA ablation between May 2005 and August 2007 using a manually controlled steerable sheath (Agilis((R)) St. Jude Medical Inc., St. Paul, MN, USA), were included. The endpoint of the ablation was the completion of predefined lesions (CPVA for paroxysmal, and CPVA+mitral isthmus and roof line ablation for persistent AF). Seven day Holter recordings were done immediately, 3, 6, and 12 month after ablation. AF longer than 30 s was considered as recurrence. The success was defined as lack of recurrence during 7-day Holter recordings done 3, 6, and 12 months after ablation. Early recurrence was defined as recurrence during the first 7-day Holter recording immediately after ablation. Forty-five and 20.8% of the patients received antiarrhythmic medications for the first 3 and 6 months after ablation procedure, respectively. After 6 months all antiarrhythmics were discontinued. About 51.5% experienced early recurrence. Twelve months success rate was 75.7% (paroxysmal: 75.7%, persistent: 75.0%, P = 1.0). Using multivariate analysis left atrial (LA) diameter > or =50 mm was the predictor of early recurrence {Hazard Ratio (HR) [95% confidence interval (CI)] = 5.1 (2.0-12.9)}. LA Diameter > or =50 mm [HR (95% CI) = 4.6 (2.6-9.1)]; early recurrence [HR (95% CI) = 4.3 (2.0-9.1)]; and arterial hypertension [HR (95% CI) = 4.6 (2.6-9.1)] were predictors of late recurrence. CONCLUSION In our patients' cohort, a single catheter ablation procedure based on CPVA using steerable sheath for catheter navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.
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Affiliation(s)
- Arash Arya
- Department of Electrophysiology, University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
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Fagan T, Dreher D, Cutright W, Jacobson J, Latson L. Fracture of the GORE HELEX septal occluder: Associated factors and clinical outcomes. Catheter Cardiovasc Interv 2009; 73:941-8. [DOI: 10.1002/ccd.21929] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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