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Goette A, Corradi D, Dobrev D, Aguinaga L, Cabrera JA, Chugh SS, de Groot JR, Soulat-Dufour L, Fenelon G, Hatem SN, Jalife J, Lin YJ, Lip GYH, Marcus GM, Murray KT, Pak HN, Schotten U, Takahashi N, Yamaguchi T, Zoghbi WA, Nattel S, Mont L, Akar JG, Akoum N, Althoff T, Diaz JC, Guichard JB, Jadidi A, Kalman J, Lim H, Teixeira RA. Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS). Europace 2024; 26:euae204. [PMID: 39077825 PMCID: PMC11431804 DOI: 10.1093/europace/euae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS The concept of "atrial cardiomyopathy" (AtCM) had been percolating through the literature since its first mention in 1972. Since then, publications using the term were sporadic until the decision was made to convene an expert working group with representation from four multinational arrhythmia organizations to prepare a consensus document on atrial cardiomyopathy in 2016 (EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication). Subsequently, publications on AtCM have increased progressively. METHODS AND RESULTS The present consensus document elaborates the 2016 AtCM document further to implement a simple AtCM staging system (AtCM stages 1-3) by integrating biomarkers, atrial geometry, and electrophysiological changes. However, the proposed AtCM staging needs clinical validation. Importantly, it is clearly stated that the presence of AtCM might serve as a substrate for the development of atrial fibrillation (AF) and AF may accelerates AtCM substantially, but AtCM per se needs to be viewed as a separate entity. CONCLUSION Thus, the present document serves as a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS) to contribute to the evolution of the AtCM concept.
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Am Busdorf 2, 33098 Paderborn, Germany
- MAESTRIA Consortium at AFNET, Münster, Germany
- Otto-von-Guericke University, Medical Faculty, Magdeburg, Germany
| | - Domenico Corradi
- Department of Medicine and Surgery, Unit of Pathology; Center of Excellence for Toxicological Research (CERT), University of Parma, Parma, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, University Duisburg-Essen, Essen, Germany
- Montréal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montréal, Québec H1T1C8, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
| | - Luis Aguinaga
- Director Centro Integral de Arritmias Tucumán, Presidente Sociedad de Cardiología de Tucumàn, Ex-PRESIDENTE DE SOLAECE (LAHRS), Sociedad Latinoamericana de EstimulaciónCardíaca y Electrofisiología, Argentina
| | - Jose-Angel Cabrera
- Hospital Universitario QuirónSalud, Madrid, Spain
- European University of Madrid, Madrid, Spain
| | - Sumeet S Chugh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Joris R de Groot
- Department of Cardiology; Cardiovascular Sciences, Heart Failure and Arrhythmias, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, Paris, France
| | | | - Stephane N Hatem
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Jose Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | - Yenn-Jiang Lin
- Cardiovascular Center, Taipei Veterans General Hospital, and Faculty of Medicine National Yang-Ming University Taipei, Taiwan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, USA
| | - Katherine T Murray
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Ulrich Schotten
- MAESTRIA Consortium at AFNET, Münster, Germany
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University and Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University and Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Takanori Yamaguchi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - William A Zoghbi
- Department of Cardiology, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Stanley Nattel
- McGill University, 3655 Promenade Sir-William-Osler, Montréal, Québec H3G1Y6, Canada
- West German Heart and Vascular Center, Institute of Pharmacology, University Duisburg, Essen, Germany
| | - Lluis Mont
- Hospital Clinic, Universitat Barcelona, Barcelona, Spain
| | - Joseph G Akar
- Director, Cardiac Electrophysiology, Professor of Medicine, Yale School of Medicine
| | | | - Till Althoff
- Hospital Clinic, Universitat Barcelona, Barcelona, Spain
| | | | - Jean-Baptiste Guichard
- Hospital Clínic de Barcelona, IDIBAPS, CIBERCV, Catalonia, Spain
- CHU de Saint-Étienne, SAINBIOSE-INSERM U1059, France
| | - Amir Jadidi
- Faculty of Medicine, University of Freiburg i.Br., Germany
- Department of Cardiology, Heart Center Lucerne - Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jonathan Kalman
- University of Melbourne & Director of Heart Rhythm Services, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Han Lim
- Austin and Northern Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ricardo Alkmim Teixeira
- Hospital Renascentista, R. Salvador dos Santos Nora 76, Santa Doroteia - Pouso Alegre (Minas Gerais), 37553-628 Brazil
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Ukita K, Egami Y, Nohara H, Kawanami S, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M. Clinical Impact of Cryoballoon Ablation for Paroxysmal Atrial Fibrillation in Patients With Enlarged Left Atrium. Am J Cardiol 2023; 208:111-115. [PMID: 37832206 DOI: 10.1016/j.amjcard.2023.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023]
Abstract
The impact of cryoballoon ablation (CBA) for atrial fibrillation (AF) in patients with enlarged left atrium (E-LA) has not been sufficiently clarified. A total of 306 patients underwent an initial CBA for paroxysmal AF between February 2017 and March 2022 in our hospital. These patients were categorized into 2 groups according to the preprocedural left atrium (LA) diameter (LAD): E-LA group with LAD ≥40 mm and normal LA (N-LA) group with LAD <40 mm. We compared late recurrence (LR, defined as a recurrence of atrial tachyarrhythmia more than 3 months after the ablation) between the 2 groups. In addition, we made a further classification of the E-LA group into a severely E-LA (SE-LA) group with LAD ≥50 mm and mildly enlarged LA (ME-LA) group with LAD <50 mm and compared LR in the SE-LA, ME-LA, and N-LA groups. In the patients who experienced a second ablation procedure owing to LR, subsequent recurrences were also evaluated. After initial CBA, there was no significant difference in recurrence-free survival between E-LA and N-LA groups (p = 0.447). In contrast, the SE-LA group showed the lowest incidence of recurrence-free survival in the SE-LA, ME-LA, and N-LA groups (p = 0.012). However, when we analyzed recurrences after the ablation including second ablation procedure, there were no significant differences in recurrence-free survival among these 3 groups (p = 0.103). In conclusion, patients with paroxysmal AF with enlarged LA showed favorable outcomes compared with those with N-LA after CBA.
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Affiliation(s)
- Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Hiroaki Nohara
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
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Eberly LA, Lin A, Park J, Khoshnab M, Garg L, Chee J, Kallan MJ, Walsh K, Supple GE, Schaller RD, Santangeli P, Riley MP, Nazarian S, Arkles J, Hyman M, Lin D, Guandalini G, Kumareswaran R, Deo R, Zado ES, Epstein A, Frankel DS, Callans DJ, Marchlinski FE, Dixit S. Presence of sinus rhythm at time of ablation in patients with persistent atrial fibrillation undergoing pulmonary vein isolation is associated with improved long-term arrhythmia outcomes. J Interv Card Electrophysiol 2023; 66:1455-1464. [PMID: 36525168 DOI: 10.1007/s10840-022-01441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adverse structural and electrical remodeling underlie persistent atrial fibrillation (PersAF). Restoration of sinus rhythm (SR) prior to ablation in PersAF may improve the underlying substrate, thus improving arrhythmia outcomes. The aim of this study was to evaluate if the presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of a limited catheter ablation (CA) strategy in PersAF. METHODS Patients with PersAF undergoing pulmonary vein isolation at our institution from 2014-2018 were included. We compared patients who presented for ablation in SR (by cardioversion and/or antiarrhythmic drugs [AADs]) to those who presented in AF. Primary outcome of interest was freedom from atrial arrhythmias (AAs) on or off AADs at 1 year after single ablation. Secondary outcomes included freedom from AAs on or off AADs overall, freedom from AAs off AADs at 1 year, and time to recurrent AF. RESULTS Five hundred seventeen patients were included (322 presented in AF, 195 SR). The primary outcome was higher in those who presented for CA in SR as compared to AF (85.6% vs. 77.0%, p = 0.017). Freedom from AAs off AAD at 12 months was also higher in those presenting in SR (59.0% vs. 44.4%; p = 0.001) and time to recurrent AF was longer (p = 0.008). Presence of SR at CA was independently associated with the primary outcome at 12 months (OR 1.77; 95% CI 1.08-2.90) and overall (OR 1.89; 95% CI 1.26-2.82). CONCLUSIONS Presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of limited CA in PersAF.
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Affiliation(s)
- Lauren A Eberly
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Aung Lin
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Joseph Park
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Mirmilad Khoshnab
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Lohit Garg
- Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz, Aurora, USA
| | - Jennifer Chee
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Michael J Kallan
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Katie Walsh
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Gregory E Supple
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Michael P Riley
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Saman Nazarian
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Jeffrey Arkles
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Matthew Hyman
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David Lin
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Gustavo Guandalini
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Ramanan Kumareswaran
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Rajat Deo
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Erica S Zado
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Andrew Epstein
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David S Frankel
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David J Callans
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Francis E Marchlinski
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Sanjay Dixit
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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Lee SR, Choi EK, Lee SW, Han KD, Oh S, Lip GY. Early Rhythm Control in Patients With Incident Atrial Fibrillation Who Had a Prior Stroke. JACC Clin Electrophysiol 2023. [PMID: 37495321 DOI: 10.1016/j.jacep.2022.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND There are limited data regarding the benefit of early rhythm control therapy for secondary prevention for stroke in patients with atrial fibrillation (AF). OBJECTIVES This study aimed to compare the risk of recurrent stroke between early rhythm control therapy and usual care in patients with new-onset AF and a history of prior stroke. METHODS Using the Korean nationwide claims database, the investigators identified patients who were newly diagnosed with AF and had a history of prior stroke. Patients who received rhythm control therapy, including antiarrhythmic drug, direct current cardioversion, or AF catheter ablation, within 1 year after incident AF were defined as the early rhythm control group, and the others were the usual care group. The propensity score weighting method was used to balance baseline characteristics between the 2 groups. Incident stroke was evaluated as a primary outcome. RESULTS A total of 53,509 patients were included (12,455 in the early rhythm control group and 41,054 in the usual care group). All patients were prescribed oral anticoagulants. During a median 2.6 years of follow-up, 4,382 patients had an incident stroke (incidence rate: 2.6 per 100 person-years). Early rhythm control was associated with a lower risk of recurrent stroke compared to the risk associated with usual care (weighted HR: 0.720; 95% CI: 0.666-0.779; P < 0.001). CONCLUSIONS Early rhythm control within 1 year after AF diagnosis might be beneficial to prevent recurrent stroke in patients with incident AF and a history of stroke. Integrated care, including optimal rhythm control with appropriate anticoagulation, should be considered in this population.
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Kugler L, Markendorf S, Bachmann M, Eriksson U. Cardiac resynchronization therapy in the presence of total atrioventricular block reduces long-lasting atrial fibrillation episodes. J Arrhythm 2022; 38:723-729. [PMID: 36237857 PMCID: PMC9535753 DOI: 10.1002/joa3.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is an ongoing debate on how cardiac resynchronization therapy (CRT) in the presence of total AV block affects atrial fibrillation (AF) episodes and symptoms in patients with AF. Methods Seventy-five patients with symptomatic, drug and ablation refractory AF received, irrespective of their left ventricular ejection fraction (EF), either a CRT device and underwent subsequent atrioventricular node (AVN) ablation or already had a total AV block and underwent CRT upgrade. Long-lasting AF episodes (>48 h), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left atrial diameter (LAD), NTproBNP levels, EHRA score, and NYHA class had been monitored on the follow-up. Results The number of patients experiencing long-lasting AF episodes (>48 h) and symptoms decreased significantly within 24 months after CRT implantation in the presence of total AV block (p < .001) from 57 (76%) to 25 (33.3%). Mean LAD decreased from 52 mm (IQR 48.0-56.0) to 48 mm (IQR 42.0-52.0, p < .001) and LVEDD from 54 mm (IQR 49.0-58.0) to 51 mm (IQR 46.5-54.0, p < .001). Conclusion A combination of total AVN block and biventricular pacing markedly reduces long-lasting AF episodes, symptoms, left atrial diameter, and left ventricular end-diastolic diameter.
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Affiliation(s)
- Lara Kugler
- Division of CardiologyGZO – Zurich Regional Health CentreWetzikonSwitzerland
- University of ZurichZurichSwitzerland
| | - Susanne Markendorf
- University of ZurichZurichSwitzerland
- Heart Center Zurich, Division of Cardiology and ElectrophysiologyZurich University HospitalZurichSwitzerland
| | - Marta Bachmann
- Division of CardiologyGZO – Zurich Regional Health CentreWetzikonSwitzerland
- University of ZurichZurichSwitzerland
| | - Urs Eriksson
- Division of CardiologyGZO – Zurich Regional Health CentreWetzikonSwitzerland
- University of ZurichZurichSwitzerland
- Heart Center Zurich, Division of Cardiology and ElectrophysiologyZurich University HospitalZurichSwitzerland
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Beltrami M, Dei LL, Milli M. The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081191. [PMID: 36013370 PMCID: PMC9410416 DOI: 10.3390/life12081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic function in several heart diseases. The LA represents a “neuroendocrine organ” with high sensitivity to the nervous, endocrine, and immune systems. New insights highlight the importance of left atrial structural, contractile, and/or electrophysiological changes, introducing the concept of “atrial cardiomyopathy”, which is closely linked to underlying heart disease, arrhythmias, and conditions such as aging. The diagnostic algorithm for atrial cardiomyopathy should follow a stepwise approach, combining risk factors, clinical characteristics, and imaging. Constant advances in imaging techniques offer superb opportunities for a comprehensive evaluation of LA function, underlying specific mechanisms, and patterns of progression. In this literature review, we aim to suggest a practical, stepwise algorithm with integrative multimodality imaging and a clinical approach for LA geometry and functional analysis. This integrates diastolic flow analysis with LA remodelling by the application of traditional and new diagnostic imaging techniques in several clinical settings such as heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), and mitral regurgitation (MR).
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
- Correspondence: ; Tel.: +39-339-541-8158
| | - Lorenzo-Lupo Dei
- Cardiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, 50142 Florence, Italy
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Ukita K, Egami Y, Kawamura A, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Impact of radiofrequency catheter ablation for atrial fibrillation in patients with left atrial enlargement. Heart Vessels 2022; 37:1899-1905. [PMID: 35567636 DOI: 10.1007/s00380-022-02094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
Little has been reported on the impact of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in patients with left atrial enlargement (LAE). A total of 706 patients underwent an initial RFCA for AF between September 2014 and September 2019 in our hospital. These patients were categorized into two groups according to the pre-procedural left atrial diameter (LAD) measured by transthoracic echocardiography (TTE): LAE group with LAD ≥ 50 mm and non-LAE group with LAD < 50 mm. We compared the patient characteristics, ablation procedures, and late recurrence of AF (LRAF, defined as a recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) between the two groups. In addition, we performed follow-up TTE at 12 months after RFCA and investigated the factors associated with left atrium (LA) reverse remodeling in each group. LAE group and non-LAE group consisted of 155 and 551 patients, respectively. There were no significant differences in ablation procedures, procedure-related complications, and the incidence of LRAF between the two groups. Furthermore, non-PAF was identified as an independent predictor of LA reverse remodeling in LAE group by multiple regression analysis (P = 0.020). RFCA might be an effective and safe procedure even in patients with LAD ≥ 50 mm, using the contemporary 3D-guided mapping and ablation technologies. Moreover, RFCA can lead to LA reverse remodeling in 1 year if they have non-PAF before ablation.
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Affiliation(s)
- Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai, Osaka, 591-8025, Japan
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P wave duration ≥150 ms predicts poor left atrial function and ablation outcomes in non-paroxysmal atrial fibrillation. J Electrocardiol 2021; 69:124-131. [PMID: 34695779 DOI: 10.1016/j.jelectrocard.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND It remains unknown whether P wave duration (PWD) ≥ 150 ms measured after extensive radiofrequency catheter ablation (RFCA) can identify non-paroxysmal atrial fibrillation (non-PAF) patients at increased risk of atrial tachyarrhythmia recurrence. We investigated the predicting power of PWD and its association with left atrial (LA) reverse remodeling in patients with non-PAF undergoing pulmonary vein isolation with LA linear ablation. METHODS We retrospectively evaluated 136 patients who underwent RFCA for drug-refractory non-PAF. Electroanatomic mapping was acquired during AF. Low-voltage area (LVA) was defined as an area with bipolar voltage ≤0.5 mV. Electrocardiography and echocardiography were performed during sinus rhythm 1 day and 3 months after RFCA. PWD was measured using amplified 12‑lead electrocardiography. Prolonged PWD was defined as maximum PWD ≥ 150 ms. RESULTS Over a mean follow-up duration of 48 ± 35 months, 28 patients experienced atrial tachyarrhythmia recurrence. PWD was positively correlated with LVA (r = 0.527, p < 0.001) and inversely correlated with LA emptying fraction (r = -0.399, p < 0.001). PWD was shortened and LA emptying fraction (LAEF) was increased in patients without atrial tachyarrhythmia recurrence during follow-up. Atrial tachyarrhythmia-free survival was significantly more likely in patients without a prolonged PWD (83.5% vs 60.7%, p = 0.002). Multivariate analysis showed that LAEF and PWD were independent predictors of atrial tachyarrhythmia recurrence. CONCLUSIONS PWD ≥ 150 ms measured after RFCA can identify patients with non-PAF at increased risk of atrial tachyarrhythmia recurrence. PWD is correlated with LVA and LAEF and reflects LA reverse remodeling.
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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.
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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
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Miwa Y, Mohri T, Katsume Y, Tashiro M, Momose Y, Nonoguchi N, Hoshida K, Togashi I, Hagiwara Y, Maeda A, Ueda A, Sato T, Soejima K. Left Atrial Reverse Remodeling Following the Modified Box Isolation with Centerline in Patients with Persistent Atrial Fibrillation. Int Heart J 2021; 62:1005-1011. [PMID: 34544979 DOI: 10.1536/ihj.21-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Esophageal injury is a rare but serious complication of atrial fibrillation (AF) ablation. To minimize esophageal injury, our persistent AF (PerAF) protocol involves complete left atrial posterior wall (LAPW) and pulmonary vein (PV) isolation (box isolation), with a centerline away from the esophagus. However, there has been a concern that extensive LA isolation might deteriorate LA function. There has been a paucity of data on LA remodeling after box isolation. Therefore, we compared LA size pre- and post-box isolation with an LAPW centerline in patients with PerAF.Patients who underwent catheter ablation (CA) for PerAF between November 2016 and December 2018 were retrospectively evaluated.The LAPW, including all PVs, was completely isolated in 105 consecutive patients (75 men; mean age: 68 ± 10 years) with PerAF, including 58 patients with long-standing PerAF. During a follow-up of 660 ± 332 days, 76 patients (72%) were arrhythmia-free. The LA dimension (38 ± 6 mm versus 42 ± 7 mm; P < 0.0001) and volume index (38 ± 13 mL/m2 versus 47 ± 14 mL/m2; P < 0.0001) at 6 months post-ablation were significantly decreased in patients who maintained sinus rhythm compared to pre-ablation. In patients with recurrent AF/atrial tachycardia (AT), these parameters were also significantly decreased (P < 0.001, respectively).Box isolation with a posterior centerline has no esophageal complications and a high clinical success rate in patients with PerAF. Reverse remodeling could be achieved even when using extensive isolation of the PV and LAPW in patients with PerAF.
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Affiliation(s)
- Yosuke Miwa
- Department of Cardiovascular Medicine, Kyorin University Hospital
| | - Takato Mohri
- Department of Cardiovascular Medicine, Kyorin University Hospital
| | - Yumi Katsume
- Department of Cardiovascular Medicine, Kyorin University Hospital
| | - Mika Tashiro
- Department of Cardiovascular Medicine, Kyorin University Hospital
| | - Yuichi Momose
- Department of Cardiovascular Medicine, Kyorin University Hospital
| | - Noriko Nonoguchi
- Department of Cardiovascular Medicine, Kyorin University Hospital
| | - Kyoko Hoshida
- Department of Cardiovascular Medicine, Kyorin University Hospital
| | - Ikuko Togashi
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | - Yo Hagiwara
- Division of Engineering, Kyorin University Hospital
| | - Akiko Maeda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | - Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital
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11
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Chen YC, Voskoboinik A, Gerche AL, Marwick TH, McMullen JR. Prevention of Pathological Atrial Remodeling and Atrial Fibrillation: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2846-2864. [PMID: 34082914 DOI: 10.1016/j.jacc.2021.04.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
Atrial enlargement in response to pathological stimuli (e.g., hypertension, mitral valve disease) and physiological stimuli (exercise, pregnancy) can be comparable in magnitude, but the diseased enlarged atria is associated with complications such as atrial fibrillation (AF), whereas physiological atrial enlargement is not. Pathological atrial enlargement and AF is also observed in a small percentage of athletes undergoing extreme/intense endurance sport and pregnant women with preeclampsia. Differences between physiological and pathological atrial enlargement and underlying mechanisms are poorly understood. This review describes human and animal studies characterizing atrial enlargement under physiological and pathological conditions and highlights key knowledge gaps and clinical challenges, including: 1) the limited ability of atria to reverse remodel; and 2) distinguishing physiological and pathological enlargement via imaging/biomarkers. Finally, this review discusses how targeting distinct molecular mechanisms underlying physiological and pathological atrial enlargement could provide new therapeutic and diagnostic strategies for preventing or reversing atrial enlargement and AF.
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Affiliation(s)
- Yi Ching Chen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Julie R McMullen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia.
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12
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Wang X, Song B, Qiu C, Han Z, Wang X, Lu W, Chen X, Chen Y, Pan L, Sun G, Qin X, Li R. The effect of left atrial remodeling after cryoballoon ablation and radiofrequency ablation for paroxysmal atrial fibrillation. Clin Cardiol 2020; 44:78-84. [PMID: 33205849 PMCID: PMC7803361 DOI: 10.1002/clc.23507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the most common procedures used to treat refractory atrial fibrillation (AF) and are performed through pulmonary vein isolation (PVI). Studies have shown that CBA can approximately match the therapeutic effects of RFA against AF. However, few studies have investigated the difference between CBA and RFA of the effects on left atrial remodeling for paroxysmal AF. Objective Atrial remodeling is considered pivotal to the occurrence and development of AF, therefore we sought to assess the influence of atrial remodeling in patients with paroxysmal AF after CBA and RFA in this study. Methods In this nonrandomized retrospective observational study, we enrolled 328 consecutive patients who underwent CBA or RFA for refractory paroxysmal AF in May 2014 to May 2017 in our hospital. After propensity score matching, 96 patients were included in the CBA group, and 96 were included in the RFA group. Patients were asked to undergo a 12‐lead electrocardiogram, a 24‐h Holter monitor, and an echocardiogram and to provide their clinical history and symptoms at 6 months and 1, 2, and 3 years postprocedurally. Electrical remodeling of the left atrium was assessed by P wave dispersion (Pdis); structural remodeling was assessed by the left atrium diameter (LAD) and left atrial volume index (LAVI) during scheduled visits. Results As of January 2020, compared with baseline, at 1 year, 2 years, and 3 years after ablation, the average changes in Pdis (∆Pdis), LAD (∆LAD), and LAVI (∆LAVI) were significant in both the CBA and RFA groups. Six months after ablation, ∆Pdis, ∆LAD, and ∆LAVI were greater in the CBA group than in the RFA group. There was no significant difference between the two groups in AF/flutter recurrence, but the AF/flutter‐free survival time of CBA group may be longer than RFA group after 2 years after ablation. A higher ∆Pdis, ∆LAD, or ∆LAVI at 1 year after ablation may increase AF/flutter‐free survival. Conclusions Although CBA and RFA are both effective in left atrial electrical and structural reverse‐remodeling in paroxysmal AF, CBA may outperform RFA for both purposes 6 months after ablation. However, during long‐term follow‐up, there was no significant intergroup difference.
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Affiliation(s)
- Xule Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Beibei Song
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Chunguang Qiu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Zhanying Han
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xi Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Wenjie Lu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xiaojie Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Yingwei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Liang Pan
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Guoju Sun
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xiaofei Qin
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Ran Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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13
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Kress DC, Erickson L, Mengesha TW, Krum D, Sra J. Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation. J Patient Cent Res Rev 2020; 7:227-238. [PMID: 32760754 DOI: 10.17294/2330-0698.1744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF. Methods Patients with persistent AF (N=108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of atrial flutter or AF was determined with ambulatory monitoring (n=22) or electrocardiogram analysis (n=86) at each follow-up visit. Recurrence mode was confirmed by electrophysiology study for those patients undergoing subsequent catheter ablation after hybrid ablation. Results Patients were followed for a mean ± standard deviation of 25 ± 14 months. Of patients who had a recurrence, 53% (n=33) were in atrial flutter and 47% (n=29) were in AF. Of those who had a recurrence with atrial flutter, 14 received repeat ablation for either left (n=11) or left/right (n=3) atrial flutter and 3 received AF ablation. Half of ablations for atrial flutter recurrence following the hybrid procedure involved the mitral isthmus. Conclusions Atrial flutter accounts for about half of arrhythmia recurrences post-hybrid ablation. If catheter ablation of the mitral isthmus is considered during the hybrid procedure to prevent subsequent occurrence of perimitral flutter, bidirectional block must be performed to ensure a complete line of block.
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Affiliation(s)
- David C Kress
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI
| | - Lynn Erickson
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Tadele W Mengesha
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - David Krum
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Jasbir Sra
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI
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Oka T, Koyama Y, Tanaka K, Hirao Y, Tanaka N, Okada M, Yoshimoto I, Kitagaki R, Okamura A, Iwakura K, Sakata Y, Fujii K, Inoue K. Early recurrence during the blanking period and left atrial reverse remodeling after catheter ablation for non-paroxysmal atrial fibrillation. IJC HEART & VASCULATURE 2020; 30:100588. [PMID: 32743045 PMCID: PMC7385444 DOI: 10.1016/j.ijcha.2020.100588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 01/14/2023]
Abstract
Background Early recurrence of atrial tachyarrhythmia (ERAT) during a 90-day blanking period (BP) often occurs after atrial fibrillation (AF) ablation. Left atrial reverse remodeling (LARR), which is the reduction in LA volume (LAV), also occurs during the BP. Both ERAT and LARR are associated with late recurrence (LR, greater than 90 days after ablation). We investigated the association between ERAT and LARR following non-paroxysmal AF (NPAF) ablation. Methods We retrospectively reviewed 330 consecutive patients undergoing initial NPAF ablation (median follow-up: 4.0 years). Based on the timing of the final ERAT, we divided the patients into No-ERAT (N = 154, without ERAT), Early (N = 39, 0–7 days after ablation), Intermediate (N = 67, 8–30), and Late-ERAT (N = 70, 31–90) groups. We assessed the extent of LARR, defined as the percentage of decrease in LAV (%ΔLAV). The %ΔLAV cutoff value was determined by receiver operating characteristic analysis, and incorporated into a multivariate analysis to assess the association between ERAT and LARR. Results Late-ERAT was associated with LR (hazard ratio: 6.31, 95% confidence interval (CI): 4.21–9.47, p = 0.0001). The %ΔLAV in the Late-ERAT group was significantly smaller than the other groups (p < 0.0001). The predictive power of %ΔLAV for LR was slight (AUC, 0.604; best cutoff, 18.8% decrease; p = 0.0011). In the multivariate logistic regression analysis, Late-ERAT was associated with poor LARR (%ΔLAV < 18.8% decrease) (odds ratio, 0.13; 95%CI, 0.06–0.27; p < 0.001), whereas Early- and Intermediate-ERAT did not show any correlation. Conclusions Late-ERAT was strongly associated with poor LARR after NPAF ablation. Both Late-ERAT and poor LARR might reflect a residual arrhythmogenic substrate causing LR.
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Affiliation(s)
- Takafumi Oka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yuko Hirao
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Issei Yoshimoto
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Ryo Kitagaki
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Katsuomi Iwakura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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Sardu C, Santulli G, Guerra G, Trotta MC, Santamaria M, Sacra C, Testa N, Ducceschi V, Gatta G, Amico MD, Sasso FC, Paolisso G, Marfella R. Modulation of SERCA in Patients with Persistent Atrial Fibrillation Treated by Epicardial Thoracoscopic Ablation: The CAMAF Study. J Clin Med 2020; 9:E544. [PMID: 32079238 PMCID: PMC7074346 DOI: 10.3390/jcm9020544] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate atrial fibrillation (AF) recurrence and Sarcoplasmic Endoplasmic Reticulum Calcium ATPase (SERCA) levels in patients treated by epicardial thoracoscopic ablation for persistent AF. BACKGROUND Reduced levels of SERCA have been reported in the peripheral blood cells of patients with AF. We hypothesize that SERCA levels can predict the response to epicardial ablation. METHODS We designed a prospective, multicenter, observational study to recruit, from October 2014 to June 2016, patients with persistent AF receiving an epicardial thoracoscopic pulmonary vein isolation. RESULTS We enrolled 27 patients. Responders (n = 15) did not present AF recurrence after epicardial ablation at one-year follow-up; these patients displayed a marked remodeling of the left atrium, with a significant reduction of inflammatory cytokines, B type natriuretic peptide (BNP), and increased levels of SERCA compared to baseline and to nonresponders (p < 0.05). Furthermore, mean AF duration (Heart rate (HR) 1.235 (1.037-1.471), p < 0.05), Left atrium volume (LAV) (HR 1.755 (1.126-2.738), p < 0.05), BNP (HR 1.945 (1.895-1.999), p < 0.05), and SERCA (HR 1.763 (1.167-2.663), p < 0.05) were predictive of AF recurrence. CONCLUSIONS Our data indicate for the first time that baseline values of SERCA in patients with persistent AF might be predictive of failure to epicardial ablative approach. Intriguingly, epicardial ablation was associated with increased levels of SERCA in responders. Therefore, SERCA might be an innovative therapeutic target to improve the response to epicardial ablative treatments.
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Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
- Department of Medical Sciences, International University of Health and Medical Sciences “Saint Camillus”, 00131Rome, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education Academic Research Unit (ITME), “Federico II” University, 80138 Naples, Italy;
- Department of Medicine, Albert Einstein College of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Montefiore University Hospital, New York, NY 10461, USA
| | - Germano Guerra
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86010, Campobasso, Italy;
| | - Maria Consiglia Trotta
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Matteo Santamaria
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (M.D.A.)
| | - Cosimo Sacra
- Cardiovascular and Arrhythmias Department, Catholic University of Sacred Heart, 86010 Campobasso, Italy; (C.S.); (N.T.)
| | - Nicola Testa
- Cardiovascular and Arrhythmias Department, Catholic University of Sacred Heart, 86010 Campobasso, Italy; (C.S.); (N.T.)
| | - Valentino Ducceschi
- Cardiovascular and Arrhythmias Department, “Vecchio Pellegrini” Hospital; 80138 Naples, Italy;
| | - Gianluca Gatta
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Michele D’ Amico
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (M.D.A.)
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
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Lim B, Kim J, Hwang M, Song JS, Lee JK, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. In situ procedure for high-efficiency computational modeling of atrial fibrillation reflecting personal anatomy, fiber orientation, fibrosis, and electrophysiology. Sci Rep 2020; 10:2417. [PMID: 32051487 PMCID: PMC7016008 DOI: 10.1038/s41598-020-59372-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/06/2019] [Indexed: 12/22/2022] Open
Abstract
We previously reported the feasibility and efficacy of a simulation-guided clinical catheter ablation of atrial fibrillation (AF) in an in-silico AF model. We developed a highly efficient realistic AF model reflecting the patient endocardial voltage and local conduction and tested its clinical feasibility. We acquired > 500 endocardial bipolar electrograms during right atrial pacing at the beginning of the AF ablation procedures. Based on the clinical bipolar electrograms, we generated simulated voltage maps by applying fibrosis and local activation maps adjusted for the fiber orientation. The software's accuracy (CUVIA2.5) was retrospectively tested in 17 patients and feasibility prospectively in 10 during clinical AF ablation. Results: We found excellent correlations between the clinical and simulated voltage maps (R = 0.933, p < 0.001) and clinical and virtual local conduction (R = 0.958, p < 0.001). The proportion of virtual local fibrosis was 15.4, 22.2, and 36.9% in the paroxysmal AF, persistent AF, and post-pulmonary vein isolation (PVI) states, respectively. The reconstructed virtual bipolar electrogram exhibited a relatively good similarities of morphology to the local clinical bipolar electrogram (R = 0.60 ± 0.08, p < 0.001). Feasibility testing revealed an in situ procedural computing time from the clinical data acquisition to wave-dynamics analyses of 48.2 ± 4.9 min. All virtual analyses were successfully achieved during clinical PVI procedures. We developed a highly efficient, realistic, in situ procedural simulation model reflective of individual anatomy, fiber orientation, fibrosis, and electrophysiology that can be applied during AF ablation.
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Affiliation(s)
- Byounghyun Lim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jaehyeok Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Minki Hwang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jun-Seop Song
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jung Ki Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hee-Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyung Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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Hori Y, Nakahara S, Fukuda R, Sato H, Ukaji T, Koshikawa Y, Nishiyama N, Ishikawa T, Kobayashi S, Taguchi I. Atrial reverse remodeling represented by the atrial conduction time in persistent atrial fibrillation patients after catheter ablation: its impact on predicting late atrial fibrillation recurrence. J Cardiol 2019; 75:521-528. [PMID: 31666177 DOI: 10.1016/j.jjcc.2019.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/18/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to examine the reduction in the atrial conduction time during the follow-up phase of catheter ablation in persistent atrial fibrillation (PsAF) patients, which would suggest atrial reverse remodeling, and to investigate its impact on predicting AF recurrence. METHODS Fifty-seven PsAF patients underwent radiofrequency catheter ablation. The P-wave to left atrial appendage (LAA) conduction time was measured by transthoracic echocardiography using tissue Doppler imaging (P-LAA TDI), within 24 h and 6 months after ablation. RESULTS The accuracy of the P-LAA TDI was confirmed by measuring the actual electrophysiological data during the ablation (90 ± 13 ms, r = 0.754, p < 0.001). The P-LAA TDI was significantly reduced (170 ± 18 msec to 159 ± 19 msec, p < 0.001) at the 6-month follow-up. Sixteen patients (28%) had an AF recurrence by 12 months of follow-up. The no-AF recurrence group had a significantly reduced P-LAA TDI 6 months later (165 ± 15 msec to 155 ± 18 msec, p < 0.001), while there was no significance in the AF recurrence group (184 ± 21 msec to 174 ± 16 msec, p = 0.091). The P-LAA TDI was a predictive factor of AF recurrence after ablation with a cut-off value of >175 msec (sensitivity = 0.750, specificity = 0.780) when measured within 24 h after ablation and >166 msec (sensitivity = 0.750, specificity = 0.756) when calculated at 6 months of follow-up. CONCLUSIONS In PsAF patients, a significant reduction in the P-LAA TDI was observed at 6 months of follow-up, which may have represented the occurrence of left atrial reverse remodeling. These findings suggested that the P-LAA TDI time in the follow-up was appropriate for predicting late AF recurrences.
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Affiliation(s)
- Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Reiko Fukuda
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hirotsugu Sato
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tomoaki Ukaji
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yuri Koshikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Naoki Nishiyama
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Long-term left atrial remodeling after ablation of persistent atrial fibrillation: 7-year follow-up by cardiovascular magnetic resonance imaging. J Interv Card Electrophysiol 2019; 58:21-27. [PMID: 31230178 DOI: 10.1007/s10840-019-00584-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/13/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Restoration of sinus rhythm in patients with persistent atrial fibrillation (ps. AF) induces reverse atrial remodeling and improvement of left ventricular function. We evaluated the effect of ablative treatment on cardiac remodeling after a long follow-up period of 7 years by cardiovascular magnetic resonance (CMR). METHODS Patients with symptomatic ps. AF underwent CMR within 7 days prior to the ablation procedure. Left atrial and ventricular volumes were measured. All patients underwent circumferential pulmonary vein isolation. At the end of follow-up (FU), a CMR and 7-day ECG registration were performed. RESULTS Forty-two patients (67 ± 9 years) were included. After a FU of 86 ± 13 months, 23 patients had a successful outcome. In these patients, LVEF improved from 56 ± 5 to 62 ± 4% (p = 0.02), but left atrial volume and ejection fraction (LAV, LAEF) remained unchanged (105 ± 25 to 98 ± 34, p = 0.44; 34 ± 10 to 36 ± 11, p = 0.6, respectively). In 14 patients with a BMI < 30 and no left ventricular hypertrophy (LVH), LAV decreased (104 ± 30 to 82 ± 26 ml, p = 0.01) and LAEF improved (33 ± 12 to 40 ± 11%, p = 0.03). In 9 patients with successful outcome and either BMI ≥ 30 or LVH, LAV increased (110 ± 26 to 125 ± 30 ml, p = 0.03) and LAEF deteriorated (35 ± 11 to 31 ± 10%, p = 0.04). CONCLUSIONS Successful ablative treatment of atrial fibrillation is associated with reverse left atrial remodeling and improvement of left atrial and ventricular function. In patients with a BMI ≥ 30 or left ventricular hypertrophy, further left atrial enlargement occurs despite successful outcome.
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Kobayashi H, Okada A, Tabata H, Shoin W, Okano T, Yoshie K, Oguchi Y, Kato K, Shoda M, Kuwahara K. Association between reactive hyperemia peripheral arterial tonometry index and atrial fibrillation recurrence after catheter ablation. IJC HEART & VASCULATURE 2019; 24:100385. [PMID: 31289745 PMCID: PMC6593202 DOI: 10.1016/j.ijcha.2019.100385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
Abstract
Background Vascular endothelial function has recently been recognized as an independent predictor of cardiovascular events. However, studies investigating its association with atrial fibrillation (AF) are lacking. This study aimed to examine association with AF recurrence and vascular endothelial function as assessed using natural logarithmic transformation of reactive hyperemia peripheral arterial tonometry index (LnRHI). Methods Ninety-nine consecutive AF patients who underwent catheter ablation (CA) at Shinshu University Hospital between September 2015 and April 2017 were enrolled. LnRHI was measured 48 to 72 h before CA using the EndoPAT system. The primary outcome was AF recurrence beyond 3 months post-ablation. Results A total of 30 (30.3%) patients experienced AF recurrence after CA over a median follow-up period of 210 days (range: 93–764 days). Female sex and low LnRHI were significantly associated with AF recurrence. In multivariate analysis, LnRHI was an independent predictor of AF recurrence (hazard ratio: 0.087, 95% confidence interval 0.015–0.51, p = 0.007). In comparison in Kaplan-Meier analysis of high LnRHI (LnRHI ≥0.52, n = 52) and low LnRHI (LnRHI ≪0.52, n = 47) groups, AF recurrence rate was significantly higher in the low LnRHI group (log-rank test, p = 0.043). A negative correlation was observed between LnRHI and AF duration, whereby LnRHI was significantly decreased when the duration of AF events exceeded 1 year. Conclusion Decreased LnRHI was associated with AF recurrence after CA and prolonged AF duration.
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Affiliation(s)
- Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yasutaka Oguchi
- Department of Cardiovascular Medicine, Aizawa Hospital, Nagano, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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20
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Echocardiographic assessment in patients with atrial fibrillation (AF) and normal systolic left ventricular function before and after catheter ablation: If AF begets AF, does pulmonary vein isolation terminate the vicious circle? Cardiol J 2019; 27:126-135. [PMID: 30701515 DOI: 10.5603/cj.a2019.0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) can be curative. There are conflicting data on whether AF associated atrial and ventricular structural remodeling reverses after ablation. The aim of this study was to evaluate the hemodynamic effect of AF ablation in patients with preserved left ventricular ejection fraction (LVEF). METHODS Forty three AF patients were studied (aged 56 ± 11 years; 29 male, 23% persistent AF, LVEF ≥ 50%) in whom RFCA was performed. Echocardiographic evaluation of atrial and ventricular diameters, volumes and strain imaging by two-dimensional speckle tracking were performed before and at least 6 months after RFCA. Nine patients had AF during baseline examination. RESULTS A significant decrease in the left (LA) and right (RA) atrial volume and an increase in the LA strain were observed 15 ± 7 months after RFCA. In the subgroup with baseline sinus rhythm, the increment in LA strain was only borderline significant. An increase in RA, right ventricular (RV) and Biatrial strain was noticed (p < 0.05). LVEF and global longitudinal strain of the left ventricle (LV), however, did not improve substantially. CONCLUSIONS Radiofrequency catheter ablation of AF in patients with preserved LV systolic function results in significant improvement in RA and RV function with a substantial reduction in LA and RA size. No deleterious impact of AF ablation on LA function was revealed.
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21
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Nagai T, Arakawa J, Hamabe A, Tabata H. Improvement of left ventricular function after successful radiofrequency catheter ablation in persistent atrial fibrillation with preserved left ventricular ejection fraction: a comprehensive echocardiographic assessment using two-dimensional speckle tracking analysis. J Echocardiogr 2018; 17:95-103. [DOI: 10.1007/s12574-018-0399-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/31/2018] [Accepted: 09/25/2018] [Indexed: 01/30/2023]
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22
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Xing Y, Xu B, Sheng X, Xu C, Peng F, Sun Y, Wang S, Guo H. Transformation from persistent atrial fibrillation to paroxysmal type after initial ablation predicts success of repeated ablation. Int J Cardiol 2018; 268:120-124. [DOI: 10.1016/j.ijcard.2018.03.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/14/2018] [Accepted: 03/09/2018] [Indexed: 11/28/2022]
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23
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Gul EE, Boles U, Haseeb S, Hopman W, Michael KA, Simpson C, Abdollah H, Baranchuk A, Redfearn D, Glover B. Contact-Force Guided Pulmonary Vein Isolation does not Improve Success Rate in Persistent Atrial Fibrillation Patients and Severe Left Atrial Enlargement: A 12-month Follow-Up Study. J Atr Fibrillation 2018; 11:2060. [PMID: 30505381 DOI: 10.4022/jafib.2060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022]
Abstract
Background Catheter ablation is a cornerstone treatment strategy in atrial fibrillation (AF). Left atrial (LA) size is one of the contributors in development of AF recurrences. The impact of contact-forced (CF) guided catheter ablation on the success rate of persistent AF patients with severe enlarged LA has not been investigated yet. Methods Sixty-six patients with diagnosis of longstanding persistent AF undergoing catheter ablation were enrolled. All patients underwent a standard transthoracic echocardiography according to the guidelines. LA size was considered severely enlarged when LA diameter was ≥ 50 mm. CF catheter ablation with a Tacticath Quartz catheter (St Jude Medical, St. Paul, MN, USA) was used in all patients. Results The mean age was 61.9 ± 9.9 years, and LAD 47.8 ± 11.6 mm. Among 66 patients with persistent AF, 32 (48%) patients were diagnosed with AF recurrences. Twenty-eight (42%) patients had severely enlarged LA. The recurrence of AF was comparable in patients with and without severe enlarged LA (47% vs. 42%, p=0.79). The recurrence of AF was lower in patients who underwent CF-guided ablation with a normal LA dimension (36 %, p=0.54). Procedure duration was longer in patients with severely enlarged LA. LA dimension was not significantly different between patients with and without AF recurrence (49.8 ± 7.9 mm vs. 45.9 ± 7.5 mm, p=0.15). LAD and was significantly correlated with the time to recurrence of AF (r:-0.60, p=0.02). Conclusion Our preliminary findings have demonstrated that CF guided ablation does not improve the success rate in longstanding persistent AF patients with severe LA enlargement.
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Affiliation(s)
- Enes E Gul
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Usama Boles
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Sohaib Haseeb
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Wilma Hopman
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Kevin A Michael
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Chris Simpson
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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24
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The Timing and Role of Atrial Fibrillation Ablation in Heart Failure Patients. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0587-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Jobs A, Schwind J, Katalinic A, Babaev V, Tilz RR, Rausch S, Thiele H, Eitel I, Eitel C. Prognostic significance of atrial fibrillation in acute decompensated heart failure with reduced versus preserved ejection fraction. Clin Res Cardiol 2018; 108:74-82. [PMID: 29987595 DOI: 10.1007/s00392-018-1321-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/27/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The prognostic impact of atrial fibrillation (AF) in patients with acute decompensated heart failure (ADHF) has not been fully elucidated yet. Aim of the present study was thus to investigate the association of AF with all-cause mortality in patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). METHODS We performed a retrospective single center study and analyzed data of 1286 patients admitted for ADHF. Patients were grouped according to AF status (i.e., "never AF", "history of AF", or "AF on admission") and type of heart failure. Patient and treatment characteristics were extracted by chart review. The primary outcome of all-cause mortality within 3 years following index hospitalization was determined by death registry linkage. RESULTS In total, 529 (41.1%), 215 (16.7%), and 542 (42.1%) patients were grouped as "never AF", "history of AF", and "AF on admission", respectively. With regard to type of heart failure, 558 (43.4%) and 728 (56.6%) had HFrEF and HFpEF, respectively. Compared to "never AF", "AF on admission" was associated with increased all-cause mortality in an adjusted Cox regression model [hazard ratio, 1.64 (95% confidence interval 1.32-2.04); P < 0.001]. However, this association remained significant only for patients with HFpEF [2.16 (1.58-2.95)], but not for patients with HFrEF [1.18 (0.85-1.63)] in a subgroup analysis (P for effect modification = 0.020). CONCLUSIONS AF is common in the setting of ADHF and is associated with increased all-cause mortality. However, this association remained significant only in patients with HFpEF, but not in patients with HFrEF.
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Affiliation(s)
- Alexander Jobs
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Ratzeburger Allee 160, 23538, Lübeck, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Julia Schwind
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Alexander Katalinic
- Institute for Cancer Epidemiology e.V., University of Lübeck, Lübeck, Germany
| | - Valentin Babaev
- Institute for Cancer Epidemiology e.V., University of Lübeck, Lübeck, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Ratzeburger Allee 160, 23538, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Stefan Rausch
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Ratzeburger Allee 160, 23538, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Ratzeburger Allee 160, 23538, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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26
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Jin X, Pan J, Wu H, Xu D. Are left ventricular ejection fraction and left atrial diameter related to atrial fibrillation recurrence after catheter ablation?: A meta-analysis. Medicine (Baltimore) 2018; 97:e10822. [PMID: 29768386 PMCID: PMC5976293 DOI: 10.1097/md.0000000000010822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/28/2018] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF), the most common form of arrhythmia, is associated with the prevalence of many common cardiovascular and cerebrovascular diseases. Catheter ablation is considered the first-line therapy for AF; however, AF recurrence is very common after catheter ablation. Studies have been performed to analyze the factors associated with AF recurrence, but none have reached a consistent conclusion on whether left ventricular ejection fraction (LVEF) and left atrial diameter (LA diameter) affect AF recurrence after catheter ablation.The databases PubMed, Embase, and the Cochrane Library were used to search for relevant studies up to September 2017. RevMan 5.3.5 software provided by the Cochrane Collaboration Network was used to conduct this meta-analysis.Thirteen studies involving 2825 patients were included in this meta-analysis. Overall, the results revealed that elevated LA diameter values were significantly associated with AF recurrence in patients after catheter ablation (MD = 2.19, 95% CI: 1.63-2.75, P < .001), while baseline LVEF levels were not significantly positively associated with AF recurrence in patients after catheter ablation (MD = -0.91, 95% CI: -1.18 to 1.67, P = .14).Overall, elevated LA diameter may be associated with AF recurrence after catheter ablation; however, there was no direct relationship between LVEF values and AF recurrence after catheter ablation when baseline LVEF values are normal or mildly decreased. Besides, because of publication bias, further studies should be performed to explore the mechanisms underlying AF recurrence.
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Affiliation(s)
- Xiao Jin
- Second School of Clinical Medicine, Guangzhou Univ Chinese Med
| | - Jianke Pan
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou Univ Chinese Med (Guangdong Provincial Hospital of Chinese Medicine)
| | - Huanlin Wu
- Second School of Clinical Medicine, Guangzhou Univ Chinese Med
- Beijing University of Chinese Medicine, Beijing, China
| | - Danping Xu
- Department of Cardiology, Second Affiliated Hospital of Guangzhou Univ Chinese Med (Guangdong Provincial Hospital of Chinese Medicine)
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27
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Sugumar H, Thomas SP, Prabhu S, Voskoboinik A, Kistler PM. How to perform posterior wall isolation in catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2017; 29:345-352. [DOI: 10.1111/jce.13397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Hariharan Sugumar
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Stuart P. Thomas
- Westmead Hospital; University of Sydney and Macquarie University; Sydney New South Wales Australia
| | - Sandeep Prabhu
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Aleksandr Voskoboinik
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Peter M. Kistler
- The Baker Heart & Diabetes Institute; Melbourne Victoria Australia
- Heart Centre; The Alfred Hospital; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
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28
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Liang JJ, Elafros MA, Muser D, Pathak RK, Santangeli P, Zado ES, Frankel DS, Supple GE, Schaller RD, Deo R, Garcia FC, Lin D, Hutchinson MD, Riley MP, Callans DJ, Marchlinski FE, Dixit S. Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004239. [PMID: 27784738 DOI: 10.1161/circep.116.004239] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transformation from persistent to paroxysmal atrial fibrillation (AF) after ablation suggests modification of the underlying substrate. We examined the nature of initial arrhythmia recurrence in patients with nonparoxysmal AF undergoing antral pulmonary vein isolation and nonpulmonary vein trigger ablation and correlated recurrence type with long-term ablation efficacy after the last procedure. METHODS AND RESULTS Three hundred and seventeen consecutive patients with persistent (n=200) and long-standing persistent (n=117) AF undergoing first ablation were included. AF recurrence was defined as early (≤6 weeks) or late (>6 weeks after ablation) and paroxysmal (either spontaneous conversion or treated with cardioversion ≤7 days) or persistent (lasting >7 days). During median follow-up of 29.8 (interquartile range: 14.8-49.9) months, 221 patients had ≥1 recurrence. Initial recurrence was paroxysmal in 169 patients (76%) and persistent in 52 patients (24%). Patients experiencing paroxysmal (versus persistent) initial recurrence were more likely to achieve long-term freedom off antiarrhythmic drugs (hazard ratio, 2.2; 95% confidence interval, 1.5-3.2; P<0.0001), freedom on/off antiarrhythmic drugs (hazard ratio, 2.5; 95% confidence interval, 1.6-3.8; P<0.0001), and arrhythmia control (hazard ratio, 5.2; 95% confidence interval, 2.9-9.2; P<0.0001) after last ablation. CONCLUSIONS In patients with persistent and long-standing persistent AF, limited ablation targeting pulmonary veins and documented nonpulmonary vein triggers improves the maintenance of sinus rhythm and reverses disease progression. Transformation to paroxysmal AF after initial ablation may be a step toward long-term freedom from recurrent arrhythmia.
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Affiliation(s)
- Jackson J Liang
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Melissa A Elafros
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Daniele Muser
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Rajeev K Pathak
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Pasquale Santangeli
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Erica S Zado
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - David S Frankel
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Gregory E Supple
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Robert D Schaller
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Rajat Deo
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Fermin C Garcia
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - David Lin
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Mathew D Hutchinson
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Michael P Riley
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - David J Callans
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Francis E Marchlinski
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.)
| | - Sanjay Dixit
- From the Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia (J.J.L., D.M., R.K.P., P.S., E.S.Z., D.S.F., G.E.S., R.D.S., R.D., F.C.G., D.L., M.D.H., M.P.R., D.J.C., F.E.M., S.D.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (M.A.E.).
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McLellan AJ, Prabhu S, Voskoboinik A, Wong MC, Walters TE, Pathik B, Morris GM, Nisbet A, Lee G, Morton JB, Kalman JM, Kistler PM. Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome. Europace 2017; 19:1958-1966. [DOI: 10.1093/europace/euw231] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/29/2016] [Indexed: 11/12/2022] Open
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Xu K, Wang Y, Wu S, Zhou L, Zhao L, Jiang W, Zhang X, Liu X. The role of superior vena cava in catheter ablation of long-standing persistent atrial fibrillation. Europace 2017; 19:1670-1675. [DOI: 10.1093/europace/euw167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/15/2016] [Indexed: 11/14/2022] Open
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Gaeta S, Bahnson TD. Impedance Guided Radiofrequency Ablation for Atrial Fibrillation: Something Old Is New Again. J Cardiovasc Electrophysiol 2016; 27:1399-1402. [PMID: 27696590 DOI: 10.1111/jce.13105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen Gaeta
- Duke Center for Atrial Fibrillation and the Clinical Cardiac Electrophysiology Section, Duke University, Durham, North Carolina, USA
| | - Tristram D Bahnson
- Duke Center for Atrial Fibrillation and the Clinical Cardiac Electrophysiology Section, Duke University, Durham, North Carolina, USA
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Kondo T, Miake J, Kato M, Ogura K, Iitsuka K, Yamamoto K. Impact of postprocedural antiarrhythmic drug therapy with bepridil on maintaining sinus rhythm after catheter ablation for persistent atrial fibrillation. J Cardiol 2016; 68:229-35. [DOI: 10.1016/j.jjcc.2015.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/23/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. J Arrhythm 2016; 32:247-78. [PMID: 27588148 PMCID: PMC4996910 DOI: 10.1016/j.joa.2016.05.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hô pitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne University, INSERM UMR_S1166, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundació n and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 429] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2016; 14:e3-e40. [PMID: 27320515 DOI: 10.1016/j.hrthm.2016.05.028] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/21/2022]
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Mounsey JP, Hummel JP. Reduction of Arrhythmia Burden and Reverse Remodeling in Patients with Persistent Atrial Fibrillation and Severe Atrial Remodeling: The Benefits of Hybrid Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:213-5. [PMID: 26718634 DOI: 10.1111/pace.12809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J Paul Mounsey
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - James P Hummel
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
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Sotomi Y, Inoue K, Tanaka K, Toyoshima Y, Oka T, Tanaka N, Nozato Y, Orihara Y, Koyama Y, Iwakura K, Sakata Y, Fujii K. Persistent left atrial remodeling after catheter ablation for non-paroxysmal atrial fibrillation is associated with very late recurrence. J Cardiol 2015; 66:370-6. [DOI: 10.1016/j.jjcc.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 02/24/2015] [Accepted: 03/02/2015] [Indexed: 11/17/2022]
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CUTLER MICHAELJ, JOHNSON JEREMY, ABOZGUIA KHALID, ROWAN SHANE, LEWIS WILLIAM, COSTANTINI OTTO, NATALE ANDREA, ZIV OHAD. Impact of Voltage Mapping to Guide Whether to Perform Ablation of the Posterior Wall in Patients With Persistent Atrial Fibrillation. J Cardiovasc Electrophysiol 2015; 27:13-21. [DOI: 10.1111/jce.12830] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/07/2015] [Accepted: 09/01/2015] [Indexed: 02/01/2023]
Affiliation(s)
- MICHAEL J. CUTLER
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - JEREMY JOHNSON
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - KHALID ABOZGUIA
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - SHANE ROWAN
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - WILLIAM LEWIS
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - OTTO COSTANTINI
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
| | - ANDREA NATALE
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
- Texas Cardiac Arrhythmia Institute; Austin Texas USA
| | - OHAD ZIV
- Heart and Vascular Center, MetroHealth Campus; Case Western Reserve University; Cleveland Ohio USA
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Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation. Int J Cardiol 2015; 184:56-61. [DOI: 10.1016/j.ijcard.2015.01.060] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/30/2014] [Accepted: 01/25/2015] [Indexed: 11/17/2022]
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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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Corradi D. Atrial fibrillation from the pathologist's perspective. Cardiovasc Pathol 2013; 23:71-84. [PMID: 24462196 DOI: 10.1016/j.carpath.2013.12.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia encountered in clinical practice, is associated with increased morbidity and mortality. Electrophysiologically, it is characterized by a high rate of asynchronous atrial cell depolarization causing a loss of atrial contractile function and irregular ventricular rates. For a long time, AF was considered as a pure functional disorder without any structural background. Only in recent years, have new mapping and imaging techniques identified atrial locations, which are very often involved in the initiation and maintenance of this supraventricular arrhythmia (i.e. the distal portion of the pulmonary veins and the surrounding atrial myocardium). Morphological analysis of these myocardial sites has demonstrated significant structural remodeling as well as paved the way for further knowledge of AF natural history, pathogenesis, and treatment. This architectural myocardial disarrangement is induced by the arrhythmia itself and the very frequently associated cardiovascular disorders. At the same time, the structural remodeling is also capable of sustaining AF, thereby creating a sort of pathogenetic vicious circle. This review focuses on current understanding about the structural and genetic bases of AF with reference to their classification, pathogenesis, and clinical implications.
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Affiliation(s)
- Domenico Corradi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University of Parma, Parma, Italy.
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