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Kamp AN, Kiper C, Russell J, Hor KN. Combined Atrial Volume is Associated with Significant Atrial Arrhythmias in Total Cavopulmonary Connection Fontan Patients. Pediatr Cardiol 2023; 44:1741-1745. [PMID: 37620579 DOI: 10.1007/s00246-023-03271-1] [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: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
Atrial arrhythmias are a common late manifestation after Fontan palliation and are known to contribute to significant morbidity and mortality. Atrial volume by cardiac magnetic resonance imaging has been increasingly used in patients with congenital heart disease with no reports in those with Fontan palliation. In acquired heart disease, left atrial volume has been shown to be a strong predictor of outcomes of sustained atrial arrhythmias, including recurrence of atrial fibrillation. We hypothesized that combined atrial volume (CAV) in patients with total cavopulmonary connection (TCPC) Fontan palliation may be associated with increased risk of significant atrial arrhythmias (SAA). This is a single center retrospective case-control study. Cases were defined as patients with TCPC Fontan palliation ≥ 18 years of age, with SAA requiring intervention. Only those with advanced imaging for 3D rendering between 2013 and 2022 were included. CAV was analyzed from a 3-dimensional (3D) data set, including both the left and right atria, excluding the Fontan baffle. Seventeen TCPC Fontan case patients and 17 control patients were included. There was no difference in age between the two groups. There was no difference between gender, type of Fontan palliation, atrio-ventricular valve regurgitation, or combined ventricular function between the two groups. CAV was higher in SAA group compared to controls, and all control patients had indexed CAV ≤ 80 mL/kg. This is the first data suggesting CAV is associated with SAA in TCPC Fontan patients. Indexed CAV ≥ 80 mL/kg may be a valuable marker for SAA risk.
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Affiliation(s)
- Anna N Kamp
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Tower Building, Suite T3234, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| | - Carmen Kiper
- Department of Pediatrics, Brenner Children's, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Jennifer Russell
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Tower Building, Suite T3234, Columbus, OH, 43205, USA
| | - Kan N Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Tower Building, Suite T3234, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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2
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Tabaja C, Younis A, Santangeli P, Madden R, Taigen T, Farwati M, Hayashi K, Braghieri L, Rickard J, Klein BM, Paul A, Dresing TJ, Martin DO, Bhargava M, Kanj M, Sroubek J, Nakagawa H, Saliba WI, Wazni OM, Hussein AA. Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01659-w. [PMID: 37848806 DOI: 10.1007/s10840-023-01659-w] [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: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) risk increases with age. We aim to assess the efficacy and safety of catheter ablation in the older population. METHODS All patients undergoing AF ablation (2013-2021) at our institution were enrolled in a prospectively maintained registry. The primary endpoint was AF recurrence. Patients were divided into 3 groups: non-elderly (< 65 years), elderly (65-75 years), and very elderly (> 75 years). Patient surveys at baseline and during follow-up were used to calculate quality of life (QoL) metrics: the AF severity score as well as the AF burden. RESULTS A total of 7020 patients were included (42% non-elderly, 42% elderly, and 16% very elderly). Periprocedural major complications were low (< 1.5%) and similar in all groups besides pericardial effusion which was more frequent with older age and similar between the elderly and very elderly. At 3 years, AF recurrence for persistent AF (PersAF) was highest in the very elderly group (48%), followed by the elderly group (42%), and was the lowest in the non-elderly group (36%). In paroxysmal AF (PAF), there was no difference in AF recurrence between the elderly and non-elderly, while the very elderly remained associated with a significantly increased risk. Multivariable Cox analysis confirmed these findings (PersAF; elderly: HR = 1.23, P = 0.003; very elderly: HR = 1.44, P < 0.001) (PAF; elderly: HR = 1.04, P = 0.62; very elderly: HR = 1.30, P = 0.01). Catheter ablation resulted in a significant improvement in quality of life, irrespective of age group. CONCLUSION Catheter ablation in elderly and very elderly patients is safe, efficacious, and associated with QoL benefits. Overall, major complications were minimal and did not differ significantly between age groups, with the exception of pericardial effusions which were higher in the elderly and very elderly compared to non-elderly adults. Very elderly patients had a higher rate of AF recurrence when compared with elderly or non-elderly patients. Nevertheless, ablation resulted in a remarkable improvement in QoL and a reduction of AF burden and AF symptoms with a similar magnitude, irrespective of age.
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Affiliation(s)
- Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Katsuhide Hayashi
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Benjamin M Klein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Aritra Paul
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Thomas J Dresing
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - David O Martin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA.
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Hopman LH, Bhagirath P, Mulder MJ, Demirkiran A, Mathari SE, van der Laan AM, van Rossum AC, Kemme MJ, Allaart CP, Götte MJ. Left atrial sphericity in relation to atrial strain and strain rate in atrial fibrillation patients. Int J Cardiovasc Imaging 2023; 39:1753-1763. [PMID: 37515682 PMCID: PMC10520187 DOI: 10.1007/s10554-023-02866-2] [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: 02/09/2023] [Accepted: 04/29/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Left atrial (LA) sphericity is a novel, geometry-based parameter that has been used to visualize and quantify LA geometrical remodeling in patients with atrial fibrillation (AF). This study examined the association between LA sphericity, and LA longitudinal strain and strain rate measured by feature-tracking in AF patients. METHODS 128 AF patients who underwent cardiovascular magnetic resonance (CMR) imaging in sinus rhythm prior to their pulmonary vein isolation (PVI) procedure were retrospectively analyzed. LA sphericity was calculated by segmenting the LA (excluding the pulmonary veins and the LA appendage) on a 3D contrast enhanced MR angiogram and comparing the resulting shape with a perfect sphere. LA global reservoir strain, conduit strain, contractile strain and corresponding strain rates were derived from cine images using feature-tracking. For statistical analysis, Pearson correlations, multivariable logistic regression analysis, and Student t-tests were used. RESULTS Patients with a spherical LA (dichotomized by the median value) had a lower reservoir strain and conduit strain compared to patients with a non-spherical LA (-15.4 ± 4.2% vs. -17.1 ± 3.5%, P = 0.02 and - 8.2 ± 3.0% vs. -9.5 ± 2.6%, P = 0.01, respectively). LA strain rate during early ventricular diastole was also different between both groups (-0.7 ± 0.3s- 1 vs. -0.9 ± 0.3s- 1, P = 0.001). In contrast, no difference was found for LA contractile strain (-7.2 ± 2.6% vs. -7.6 ± 2.2%, P = 0.30). CONCLUSIONS LA passive strain is significantly impaired in AF patients with a spherical LA, though this relation was not independent from LA volume.
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Affiliation(s)
- Luuk H.G.A. Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mark J. Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Sulayman El Mathari
- Department of Cardiothoracic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anja M. van der Laan
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Michiel J.B. Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Marco J.W. Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Dept. of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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4
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Gunturiz-Beltrán C, Nuñez-Garcia M, Althoff TF, Borràs R, Figueras I Ventura RM, Garre P, Caixal G, Prat-González S, Perea RJ, Benito EM, Tolosana JM, Arbelo E, Roca-Luque I, Brugada J, Sitges M, Mont L, Guasch E. Progressive and Simultaneous Right and Left Atrial Remodeling Uncovered by a Comprehensive Magnetic Resonance Assessment in Atrial Fibrillation. J Am Heart Assoc 2022; 11:e026028. [PMID: 36216438 DOI: 10.1161/jaha.122.026028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Left atrial structural remodeling contributes to the arrhythmogenic substrate of atrial fibrillation (AF), but the role of the right atrium (RA) remains unknown. Our aims were to comprehensively characterize right atrial structural remodeling in AF and identify right atrial parameters predicting recurrences after ablation. Methods and Results A 3.0 T late gadolinium enhanced-cardiac magnetic resonance was obtained in 109 individuals (9 healthy volunteers, 100 patients with AF undergoing ablation). Right and left atrial volume, surface, and sphericity were quantified. Right atrial global and regional fibrosis burden was assessed with validated thresholds. Patients with AF were systematically followed after ablation for recurrences. Progressive right atrial dilation and an increase in sphericity were observed from healthy volunteers to patients with paroxysmal and persistent AF; fibrosis was similar among the groups. The correlation between parameters recapitulating right atrial remodeling was mild. Subsequently, remodeling in both atria was compared. The RA was larger than the left atrium (LA) in all groups. Fibrosis burden was higher in the LA than in the RA of patients with AF, whereas sphericity was higher in the LA of patients with persistent AF only. Fibrosis, volume, and surface of the RA and LA, but not sphericity, were strongly correlated. Tricuspid regurgitation predicted right atrial volume and shape, whereas diabetes was associated with right atrial fibrosis burden; sex and persistent AF also predicted right atrial volume. Fibrosis in the RA was mostly located in the inferior vena cava-RA junction. Only right atrial sphericity is significantly associated with AF recurrences after ablation (hazard ratio, 1.12 [95% CI, 1.01-1.25]). Conclusions AF progression associates with right atrial remodeling in parallel with the LA. Right atrial sphericity yields prognostic significance after ablation.
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Affiliation(s)
- Clara Gunturiz-Beltrán
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Marta Nuñez-Garcia
- Electrophysiology and Heart Modeling Institute (IHU LIRYC) Pessac France.,Université de Bordeaux Bordeaux France
| | - Till F Althoff
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Department of Cardiology and Angiology, Charite ́ University Medicine Berlin, Charite ́ Campus Mitte Berlin Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Roger Borràs
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Salud Mental Instituto de Salud Carlos III Madrid Spain
| | | | - Paz Garre
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain
| | - Gala Caixal
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain
| | - Susanna Prat-González
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Rosario J Perea
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Eva Maria Benito
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain
| | - Jose Maria Tolosana
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Elena Arbelo
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Josep Brugada
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Marta Sitges
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Lluís Mont
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Eduard Guasch
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
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5
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O’Neill L, Sim I, O’Hare D, Whitaker J, Mukherjee RK, Razeghi O, Niederer S, Wright M, Chiribiri A, Frigiola A, O’Neill MD, Williams SE. CArdiac MagnEtic resonance assessment of bi-Atrial fibrosis in secundum atrial septal defects patients: CAMERA-ASD study. Eur Heart J Cardiovasc Imaging 2022; 23:1231-1239. [PMID: 34568942 PMCID: PMC9365304 DOI: 10.1093/ehjci/jeab188] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS Atrial septal defects (ASD) are associated with atrial arrhythmias, but the arrhythmia substrate in these patients is poorly defined. We hypothesized that bi-atrial fibrosis is present and that right atrial fibrosis is associated with atrial arrhythmias in ASD patients. We aimed to evaluate the extent of bi-atrial fibrosis in ASD patients and to investigate the relationships between bi-atrial fibrosis, atrial arrhythmias, shunt fraction, and age. METHODS AND RESULTS Patients with uncorrected secundum ASDs (n = 36; 50.4 ± 13.6 years) underwent cardiac magnetic resonance imaging with atrial late gadolinium enhancement. Comparison was made to non-congenital heart disease patients (n = 36; 60.3 ± 10.5 years) with paroxysmal atrial fibrillation (AF). Cardiac magnetic resonance parameters associated with atrial arrhythmias were identified and the relationship between bi-atrial structure, age, and shunt fraction studied. Bi-atrial fibrosis burden was greater in ASD patients than paroxysmal AF patients (20.7 ± 14% vs. 10.1 ± 8.6% and 14.8 ± 8.5% vs. 8.6 ± 6.1% for right and left atria respectively, P = 0.001 for both). In ASD patients, right atrial fibrosis burden was greater in those with than without atrial arrhythmias (33.4 ± 18.7% vs. 16.8 ± 10.3%, P = 0.034). On receiver operating characteristic analysis, a right atrial fibrosis burden of 32% had a 92% specificity and 71% sensitivity for predicting the presence of atrial arrhythmias. Neither age nor shunt fraction was associated with bi-atrial fibrosis burden. CONCLUSION Bi-atrial fibrosis burden is greater in ASD patients than non-congenital heart disease patients with paroxysmal AF. Right atrial fibrosis is associated with the presence of atrial arrhythmias in ASD patients. These findings highlight the importance of right atrial fibrosis to atrial arrhythmogenesis in ASD patients.
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Affiliation(s)
- Louisa O’Neill
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Iain Sim
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Daniel O’Hare
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - John Whitaker
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Rahul K Mukherjee
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Orod Razeghi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Steven Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Matthew Wright
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | | | - Mark D O’Neill
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
| | - Steven E Williams
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North, Wing, St. Thomas’, Hospital, London SE1 7EH, UK
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6
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Boriani G, Vitolo M, Imberti JF. Atrial cardiomyopathy: a derangement in atrial volumes, geometry, function, and pathology with important clinical implications. J Cardiovasc Med (Hagerstown) 2022; 23:359-362. [PMID: 35645026 DOI: 10.2459/jcm.0000000000001316] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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7
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Buffle E, Johner N, Namdar M, Shah D. Changes in LA volume and diameter correlate with mechanisms of recurrence after paroxysmal AF ablation. Indian Heart J 2022; 74:260-261. [PMID: 35307399 PMCID: PMC9243613 DOI: 10.1016/j.ihj.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022] Open
Abstract
Papathanasiou et al point out that the two different methods of LA volume and diameter measurement in our recent publication could limit the significance of the correlations we reported with PV reconnection and non-PV foci as mechanisms of post AF ablation recurrence. While we acknowledge the lack of statistically significant correlations of smaller echo derived LA diameter with PV reconnection or of a larger angiographic LA volume with non-PV foci, the congruent confidence intervals of this correlation suggest a statistical trend. Non-uniform LA dimensional changes as an expression of structural remodelling may also be a possible explanation. Published data indicates that angiographic LA volumes consistently exhibit a positive bias compared to echocardiographic volumes but do provide intra-procedural measurements better correlating with gold standard techniques like CT or MRI. Finally we agree with Papathanasiou et al that dynamic changes in LA dimensions likely correlate with early and late mechanisms of recurrence and merit prospective studies.
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8
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Hopman LHGA, Bhagirath P, Mulder MJ, Eggink IN, van Rossum AC, Allaart CP, Götte MJW. Extent of Left Atrial Fibrosis Correlates with Descending Aorta Proximity at 3D Late Gadolinium Enhancement Cardiac MRI in Patients with Atrial Fibrillation. Radiol Cardiothorac Imaging 2022; 4:e210192. [PMID: 35795718 PMCID: PMC8893208 DOI: 10.1148/ryct.210192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 05/04/2023]
Abstract
PURPOSE To determine whether the distance between the descending aorta and left atrial (LA) wall correlates with the amount of fibrosis quantified in the posterior left inferior pulmonary vein (LIPV) area of the LA in patients with atrial fibrillation (AF). MATERIALS AND METHODS In this retrospective study, patients with AF underwent cardiac MRI in sinus rhythm prior to a pulmonary vein isolation procedure (July 2018 to February 2020). The mean distance (distancemean) and shortest distance (distanceshort) between the descending aorta and the LA wall were measured on three-dimensional (3D) contrast-enhanced MR angiograms; distancemean was defined as the average of five measurements at different levels between the descending aorta and the LA wall. The extent of LA fibrosis, both global fibrosis and regional fibrosis within the LIPV area, was derived from postprocessed, 3D, late gadolinium-enhanced images. Associations between the extent of fibrosis and the proximity of the descending aorta were analyzed by using correlative and multivariable analyses. RESULTS A total of 47 (mean age, 60 years ± 8 [standard deviation]; 31 men) patients were included for analysis. The extent of fibrosis in the posterior LIPV area was correlated with the distancemean (r s = -0.48; P < .01) and distanceshort (r s = -0.49; P < .01). Patients with a short distance between the descending aorta and LA wall (defined as a distanceshort < 2 mm) had a higher percentage of fibrosis in the posterior LIPV area than patients with a distanceshort greater than 2 mm (38.7% ± 22.7 vs 21.2% ± 17.8; P < .01). CONCLUSION The distance between the descending aorta and LA was correlated with the extent of quantified fibrosis within the posterior LIPV area.Keywords: MRI, Cardiac, Left Atrium Supplemental material is available for this article. © RSNA, 2022.
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Liu H, Gu Z, Zhu C, Li M, Jiao J, Chen H, Yang G, Ju W, Gu K, Zhang F, Chen LY, Yang D, Chen M. ECG Predictors for New-Onset Atrial Fibrillation Within a Year After Radiofrequency Ablation of Counterclockwise-Rotating Atrial Flutter. Front Cardiovasc Med 2021; 8:739350. [PMID: 34869644 PMCID: PMC8632776 DOI: 10.3389/fcvm.2021.739350] [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: 07/10/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background: New-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL) is not rare. This study aimed to investigate the predictive value of electrocardiographic parameters on new-onset AF post-typical AFL ablation. Methods: A total of 158 consecutive patients (79.1% males, mean age 57.8 ± 14.3 years) with typical AFL were enrolled between January 2012 and August 2017 in this single-center study. Patients with a history of AF before ablation were excluded. ECGs during sinus rhythm (SR) and AFL were collected. The duration of the negative component of flutter wave in lead II (DFNII), proportion of the DFNII of the total circle length of AFL (DFNII%), amplitude of the negative component of flutter wave in lead II (AFNII), duration (DPNV1), and amplitude (APNV1) of negative component of the P wave in lead V1, and P wave duration in lead II (DPII) during sinus rhythm were measured. Results: During a median follow-up of 26.9 ± 11.8 months, 22 cases (13.9%) developed new-onset AF. DFNII was significantly longer in patients with new-onset AF compared to patients without AF (114.7 ± 29.6 ms vs. 82.7 ± 12.8 ms, p < 0.0001). AFNII was significantly lower (0.118 ± 0.034 mV vs. 0.168 ± 0.051 mV, p < 0.0001), DPII (144.21 ± 23.77 ms vs. 111.46 ± 14.19 ms, p < 0.0001), and DPNV1 was significantly longer (81.07 ± 16.87 ms vs. 59.86 ± 14.42 ms, p < 0.0001) in patients with new-onset AF. In the multivariate analysis, DFNII [odds ratio (OR), 1.428; 95% CI, 1.039–1.962; p = 0.028] and DPII (OR, 1.429; 95% CI, 1.046–1.953; p = 0.025) were found to be independently associated with new-onset AF after typical AFL ablation. Conclusion: Parameters representing left atrial activation time under both the SR and AFL were independently associated with new-onset AF post-typical AFL ablation and may be useful in risk prediction, which needs to be confirmed by further prospective studies.
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Affiliation(s)
- Hailei Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhoushan Gu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Zhu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jincheng Jiao
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Gu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengxiang Zhang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Di Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Liu HT, Yang CH, Lee HL, Chang PC, Wo HT, Wen MS, Wang CC, Yeh SJ, Chou CC. Clinical Outcomes of low-voltage area-guided left atrial linear ablation for non-paroxysmal atrial fibrillation patients. PLoS One 2021; 16:e0260834. [PMID: 34855901 PMCID: PMC8638894 DOI: 10.1371/journal.pone.0260834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background The therapeutic effect of low-voltage area (LVA)-guided left atrial (LA) linear ablation for non-paroxysmal atrial fibrillation (non-PAF) is uncertain. We aimed to investigate the efficacy of LA linear ablation based on the preexisting LVA and its effects on LA reverse remodeling in non-PAF patients. Methods We retrospectively evaluated 145 consecutive patients who underwent radiofrequency catheter ablation for drug-refractory non-PAF. CARTO-guided bipolar voltage mapping was performed in atrial fibrillation (AF). LVA was defined as sites with voltage ≤ 0.5 mV. If circumferential pulmonary vein isolation couldn’t convert AF into sinus rhythm, additional LA linear ablation was performed preferentially at sites within LVA. Results After a mean follow-up duration of 48 ± 33 months, 29 of 145 patients had drugs-refractory AF/LA tachycardia recurrence. Low LA emptying fraction, large LA size and high extent of LVA were associated with AF recurrence. There were 136 patients undergoing LA linear ablation. The rate of linear block at the mitral isthmus was significantly higher via LVA-guided than non-LVA-guided linear ablation. Patients undergoing LVA-guided linear ablation had larger LA size and higher extent of LVA, but the long-term AF/LA tachycardia-free survival rate was higher than the non-LVA-guided group. The LA reverse remodeling effects by resuming sinus rhythm were noted even in patients with a diseased left atrium undergoing extensive LA linear ablation. Conclusions LVA-guided linear ablation through targeting the arrhythmogenic LVA and reducing LA mass provides a better clinical outcome than non-LVA guided linear ablation, and outweighs the harmful effects of iatrogenic scaring in non-PAF patients.
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Affiliation(s)
- Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Hung-Ta Wo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - San-Jou Yeh
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail:
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11
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Guo F, Li C, Yang L, Chen C, Chen Y, Ni J, Fu R, Jiao Y, Meng Y. Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablation. J Cardiovasc Med (Hagerstown) 2021; 22:909-916. [PMID: 34506349 DOI: 10.2459/jcm.0000000000001255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To quantitatively investigate the impact of left atrial geometric remodeling on atrial fibrillation recurrence after catheter ablation. METHODS A retrospective analysis of 105 patients with atrial fibrillation who underwent coronary computed tomographic angiography before catheter ablation. Risk factors for atrial fibrillation recurrence were identified by multivariable logistic regression analysis and used to create a nomogram. RESULTS After at least 12 months of follow-up, 30 patients (29%) developed recurrent atrial fibrillation. Patients with recurrence had higher left atrial volume, left atrial sphericity, and lower left atrial ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that left atrial minimal volume index (LAVImin) [odds ratio (OR): 1.026, 95% confidence interval (CI): 1.002-1.050, P = 0.034], left atrial sphericity (OR: 1.222, 95% CI: 1.040-1.435, P = 0.015) and CHADS2 score (OR: 1.511, 95% CI: 1.024-2.229, P = 0.038) were independent predictors of atrial fibrillation recurrence. The combined model of the left atrial sphericity to the LAVImin substantially increased the predictive power for atrial fibrillation recurrence [area under the curve (AUC) = 0.736, 95% CI: 0.627-0.844, P < 0.001], with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.772 (95% CI: 0.670-0.875) and had good internal validity. CONCLUSION The CHADS2 score, left atrial sphericity, and LAVImin were significant and independent predictors of atrial fibrillation recurrence after catheter ablation. Furthermore, the nomogram had a better predictive capacity for atrial fibrillation recurrence.
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Affiliation(s)
- Fuqian Guo
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
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12
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Echocardiography-derived total atrial conduction time (PA-TDI duration): risk stratification and guidance in atrial fibrillation management. Clin Res Cardiol 2021; 110:1734-1742. [PMID: 34453577 PMCID: PMC8563556 DOI: 10.1007/s00392-021-01917-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is a major cause of cardiovascular morbidity and mortality. To early detect and to avoid AF-related complications, several cardiac imaging modalities and approaches aim to quantify the severity of the underlying atrial cardiomyopathy (i.e., the extent of atrial remodeling). However, most established cardiac imaging modalities just incorporate single components of atrial remodeling and do not reflect the complete multifactorial process, which may contribute to their limited predictive value. Echocardiography-derived PA-TDI duration is a sophisticated echocardiographic parameter to assess total atrial conduction time and directly reflects both electrical and structural changes to the atria. Therefore, PA-TDI duration provides a more comprehensive quantification of the extent of atrial remodeling than other imaging modalities. In this article we review the role of PA-TDI duration as a marker of atrial remodeling and summarize the available data on PA-TDI duration to identify patients at risk for AF, as well as to guide AF management. Moreover, we discuss how to assess PA-TDI duration and provide recommendations on the implementation of PA-TDI duration into routine clinical care.
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13
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Ghafouri K, Franke KB, Foo FS, Stiles MK. Clinical utility of cardiac magnetic resonance imaging to assess the left atrium before catheter ablation for atrial fibrillation - A systematic review and meta-analysis. Int J Cardiol 2021; 339:192-202. [PMID: 34303756 DOI: 10.1016/j.ijcard.2021.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/04/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
AIMS This systematic review and meta-analysis aims to clarify the role of pre-procedural cardiac magnetic resonance imaging (MRI) in identifying the association between left atrial (LA) characteristics and post-ablation atrial fibrillation (AF) recurrence. These characteristics include LA fibrosis, emptying function, sphericity, volume, volume index, peak strain and post-contrast T1 relaxation time. METHODS PubMed, EMBASE, and Cochrane were searched up to July 2020 for English language articles reporting the use of cardiac MRI in catheter ablation for AF. Studies reporting the prognostic value of pre-ablation cardiac MRI were included. All references and citations were filtered for relevant manuscripts. RESULTS Twenty-four publications were identified. Every 10% increase in LA fibrosis was associated with a 1.54-fold increase in post-ablation AF recurrence (95%CI: 1.39-1.70, I2 = 50.1%). Every 10 ml increase in LA volume resulted in a hazard ratio of 1.07 (95%CI:1.03-1.12; I2 = 41.4%) for post-ablation AF recurrence. For LA sphericity, there was no significant association with post-ablation AF recurrence (HR: 1.032 [95%CI: 0.962-1.103, I2 = 49.6%). Egger's test was non-significant for publication bias in all meta-analyses. LA volume index, emptying function, peak strain and post-contrast LA T1 relaxation time had insufficient compatible publications to conduct a meta-analysis. CONCLUSION LA fibrosis quantified by cardiac MRI is associated with risk of AF recurrence after AF ablation, while increased LA volume is associated with AF recurrence to a lesser extent. There remains insufficient evidence to support the routine measurement of LA sphericity, LA volume index, LA emptying function, peak strain and LA T1 relaxation time to predict AF recurrence after AF ablation.
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Affiliation(s)
- Khashayar Ghafouri
- The university of Auckland, Faculty of Medical and Health Sciences, 85 Park Road, Grafton, 1023 Auckland, New Zealand..
| | - Kyle B Franke
- The University of Adelaide, Adelaide Medical School, North Terrace, Adelaide, South Australia 5005, Australia
| | - Fang Shawn Foo
- Peter Rothwell Academic Centre, Waikato Hospital, Pembroke Street, 3240 Hamilton, New Zealand; North Shore Hospital, 124 Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Martin K Stiles
- The university of Auckland, Faculty of Medical and Health Sciences, 85 Park Road, Grafton, 1023 Auckland, New Zealand.; Peter Rothwell Academic Centre, Waikato Hospital, Pembroke Street, 3240 Hamilton, New Zealand
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14
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Gimelli A, Ernst S, Liga R. Multi-Modality Imaging for the Identification of Arrhythmogenic Substrates Prior to Electrophysiology Studies. Front Cardiovasc Med 2021; 8:640087. [PMID: 33996938 PMCID: PMC8113383 DOI: 10.3389/fcvm.2021.640087] [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: 12/10/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Noninvasive cardiac imaging is crucial for the characterization of patients who are candidates for cardiac ablations, for both procedure planning and long-term management. Multimodality cardiac imaging can provide not only anatomical parameters but even more importantly functional information that may allow a better risk stratification of cardiac patients. Moreover, fusion of anatomical and functional data derived from noninvasive cardiac imaging with the results of endocavitary mapping may possibly allow a better identification of the ablation substrate and also avoid peri-procedural complications. As a result, imaging-guided electrophysiological procedures are associated with an improved outcome than traditional ablation procedures, with a consistently lower recurrence rate.
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Affiliation(s)
| | - Sabine Ernst
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Riccardo Liga
- Cardiothoracic and Vascular Department, Università di Pisa, Pisa, Italy
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15
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Mangiafico V, Saberwal B, Lavalle C, Raharja A, Ahmed Z, Papageorgiou N, Ahsan S. The role of CT in detecting AF substrate. Trends Cardiovasc Med 2020; 31:457-466. [PMID: 33068722 DOI: 10.1016/j.tcm.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Despite technological advancements and evolving ablation strategies, atrial fibrillation catheter ablation outcome remains suboptimal for a cohort of patients. Imaging-based biomarkers have the potential to play a pivotal role in the overall assessment and prognostic stratification of AF patients, allowing for tailored treatments and individualized care. Alongside consolidated evaluation parameters, novel imaging biomarkers that can detect and stage the remodelling process and correlate it to electrophysiological phenomena are emerging. This review aims to provide a better understanding of the different types of atrial substrate, and how Computed Tomography can be used as a pre-ablation risk stratification tool by assessing the various novel imaging biomarkers, providing a valuable insight into the mechanisms that sustain AF and potentially allowing for a patient-specific ablation strategy.
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Affiliation(s)
- Valentina Mangiafico
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Bunny Saberwal
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Antony Raharja
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Zuhair Ahmed
- Queen Mary University of London, London, England.
| | | | - Syed Ahsan
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
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16
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Uslu F, Varela M, Bharath AA. A Semi-Automatic Method To Segment The Left Atrium in MR Volumes With Varying Slice Numbers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1198-1202. [PMID: 33018202 DOI: 10.1109/embc44109.2020.9175749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with dramatic increases in mortality and morbidity. Atrial cine MR images are increasingly used in the management of this condition, but there are few specific tools to aid in the segmentation of such data. Some characteristics of atrial cine MR (thick slices, variable number of slices in a volume) preclude the direct use of traditional segmentation tools. When combined with scarcity of labelled data and similarity of the intensity and texture of the left atrium (LA) to other cardiac structures, the segmentation of the LA in CINE MRI becomes a difficult task. To deal with these challenges, we propose a semi-automatic method to segment the left atrium (LA) in MR images, which requires an initial user click per volume. The manually given location information is used to generate a chamber location map to roughly locate the LA, which is then used as an input to a deep network with slightly over 0.5 million parameters. A tracking method is introduced to pass the location information across a volume and to remove unwanted structures in segmentation maps. According to the results of our experiments conducted in an in-house MRI dataset, the proposed method outperforms the U-Net [1] with a margin of 20 mm on Hausdorff distance and 0.17 on Dice score, with limited manual interaction.
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17
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Packer M. Effect of catheter ablation on pre-existing abnormalities of left atrial systolic, diastolic, and neurohormonal functions in patients with chronic heart failure and atrial fibrillation. Eur Heart J 2020; 40:1873-1879. [PMID: 31081029 PMCID: PMC6568203 DOI: 10.1093/eurheartj/ehz284] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/27/2019] [Accepted: 05/01/2019] [Indexed: 12/21/2022] Open
Abstract
The critical role of the left atrium (LA) in cardiovascular homoeostasis is mediated by its reservoir, conduit, systolic, and neurohormonal functions. Atrial fibrillation is generally a reflection of underlying disease of the LA, especially in patients with heart failure. Disease-related LA remodelling leads to a decline in both atrial contractility and distensibility along with an impairment in the control of neurohormonal systems that regulate intravascular volume. Catheter ablation can lead to further injury to the atrial myocardium, as evidenced by post-procedural troponin release and tissue oedema. The cardiomyocyte loss leads to replacement fibrosis, which may affect up to 30-35% of the LA wall. These alterations further impair atrial force generation and neurohormonal functions; the additional loss of atrial distensibility can lead to a 'stiff LA syndrome', and the fibrotic response predisposes to recurrence of the atrial arrhythmia. Although it intends to restore LA systole, catheter ablation often decreases the chamber's transport functions. This is particularly likely in patients with long-standing atrial fibrillation and pre-existing LA fibrosis, especially those with increased epicardial adipose tissue (e.g. patients with obesity, diabetes and/or heart failure with a preserved ejection fraction). Although the fibrotic LA in these individuals is an ideal substrate for the development of atrial fibrillation, it may be a suboptimal substrate for catheter ablation. Such patients are not likely to experience long-term restoration of sinus rhythm, and catheter ablation has the potential to worsen their haemodynamic and clinical status. Further studies in this vulnerable group of patients are needed.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 N. Hall Street, Dallas, TX, USA.,Imperial College, London, UK
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18
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Mulder MJ, Kemme MJB, Visser CL, Hopman LHGA, van Diemen PA, van de Ven PM, Götte MJW, Danad I, Knaapen P, van Rossum AC, Allaart CP. Left atrial sphericity as a marker of atrial remodeling: Comparison of atrial fibrillation patients and controls. Int J Cardiol 2020; 304:69-74. [PMID: 32005449 DOI: 10.1016/j.ijcard.2020.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left atrial (LA) sphericity has been proposed as a more sensitive marker of atrial fibrillation (AF)-associated atrial remodeling compared to traditional markers such as LA size. However, mechanisms that underlie changes in LA sphericity are not fully understood and studies investigating the predictive value of LA sphericity for AF ablation outcome have yielded conflicting results. The present study aimed to assess correlates of LA sphericity and to compare LA sphericity in subjects with and without AF. METHODS Measures of LA size (LA diameter, LA volume, LA volume index), LA sphericity and thoracic anteroposterior diameter (APd) at the level of the LA were determined using computed tomography (CT) imaging data in 293 AF patients (62% paroxysmal AF) and 110 controls. RESULTS LA diameter (40.1 ± 6.8 mm vs. 35.2 ± 5.1 mm; p < 0.001), LA volume (116.0 ± 33.0 ml vs. 80.3 ± 22.6 ml; p < 0.001) and LA volume index (56.1 ± 15.3 ml/m2 vs. 41.6 ± 11.1 ml/m2; p < 0.001) were significantly larger in AF patients compared to controls, also after adjustment for covariates. LA sphericity did not differ between AF patients and controls (83.7 ± 2.9 vs. 83.9 ± 2.4; p = 0.642). Multivariable linear regression analysis demonstrated that LA diameter, LA volume, female sex, body length and thoracic APd were independently associated with LA sphericity. CONCLUSIONS The present study suggests that thoracic constraints rather than the presence of AF determine LA sphericity, implying LA sphericity to be unsuitable as a marker of AF-related atrial remodeling.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Charlotte L Visser
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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19
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D'Ambrosio G, Romano S, Alothman O, Frommhold M, Borisov G, El Garhy M, Issa K, Penco M, Raffa S, Geller JC. Computed tomography-derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low-voltage zones in patients with atrial fibrillation: The ZAQ score. J Cardiovasc Electrophysiol 2020; 31:895-902. [PMID: 32048774 DOI: 10.1111/jce.14391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/01/2020] [Accepted: 02/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pulmonary vein isolation is the cornerstone of catheter ablation in patients with atrial fibrillation (AF). However, with advanced left atrial (LA) structural changes, additional targeted catheter ablation of low-voltage zones (LVZs) has produced favorable results. Therefore, with the advent of single-shot techniques, it would be helpful to predict the presence of LVZs before an ablation procedure. OBJECTIVE We hypothesized that computed tomography (CT)-derived left atrial volume index (LAVI), in combination with other objective parameters, could be used to develop a score able to predict the presence of LVZs. METHODS In a large cohort of patients undergoing their first AF ablations, comprehensive echocardiographic evaluations and cardiac CT were performed. During the electrophysiological studies, LA geometry and electroanatomic voltage maps were created. LVZs were defined as areas ≥1 cm2 with bipolar peak-to-peak voltage amplitudes ≤0.5 mV. RESULTS In a derivation cohort of 374 patients, predictors of LVZs were identified by regression analysis and used to build the Zentralklinik Bad Berka and University of L'Aquila (ZAQ) score (age ≥65 years; female sex; and CT-LAVI ≥57 mL/m2 ). The ZAQ score of 2 points accurately identified the presence and the extent of LVZs (area under the curve [AUC], 0.809; 95% confidence interval [CI], 0.758-0.861; P < .001 and 3 [interquartile range, IQR, 1.5-4.5] vs 7 cm2 [IQR 4-9]; P = .001). In a validation cohort of 103 patients, the predictive value of the score was confirmed (AUC, 0.793; 95% CI, 0.709-0.878; P < .001 and 4 [IQR, 2-7] vs 11.5 cm2 [IQR, 8-16.5]; P = .001). CONCLUSIONS The ZAQ score identifies LVZs and may be useful for planning the ablation strategy ahead of time.
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Affiliation(s)
- Gabriele D'Ambrosio
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.,Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Silvio Romano
- Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Obaida Alothman
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Markus Frommhold
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Georgi Borisov
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - Karam Issa
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Maria Penco
- Department of Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Santi Raffa
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - J Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.,Faculty of Medicine, Otto-von-Guericke University, Magdeburg, Germany
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20
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Trotta O, Alarcón F, Guasch E, Benito EM, San Antonio R, Perea RJ, Prat-Gonzalez S, Apolo J, Sitges M, Tolosana JM, Mont L. Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:638-646. [PMID: 31957087 DOI: 10.1111/jce.14358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Ablation with second-generation cryoballoon technology evolves as an effective and safe alternative to radiofrequency for atrial fibrillation ablation procedures. Nevertheless, the optimal freezing strategy remains unknown. Our objective was to identify the procedural cryoablation parameters predicting successful peri-pulmonary vein (PV) lesions by directly analyzing Postablation gaps in late-gadolinium-enhanced cardiac magnetic resonance (LGE-CMR). METHODS AND RESULTS Forty-nine consecutive patients (196 PVs) undergoing ablation with second-generation cryoballoon at our center were included. The number and duration of cryoballoon application to achieve PV isolation were left to operator discretion. Gap number and length were quantified in all patients with a LGE-CMR performed 3 months postablation. Application time (420 ± 217 seconds), number of applications (2.1 ± 1.2), application time after electrical isolation (311 ± 194 seconds) and minimum temperature (-45.8 ± 6.5°C) were similar in the 4 PVs. Gaps were observed in 148 PVs (76%), averaging 1.3 ± 1 gaps per vein. Gaps were longer and more frequent in the right PVs (91% vs 59% in left PVs, P < .001). Neither the number, total duration of applications, nor postisolation application time predicted relative length or number of gaps. CONCLUSIONS After successful PV isolation was achieved in patients undergoing cryoablation, increasing the number of applications, the total application time or application time postisolation did not result in a reduction in the number or the relative length of gaps.
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Affiliation(s)
- Omar Trotta
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francisco Alarcón
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Guasch
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Maria Benito
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Rodolfo San Antonio
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rosario J Perea
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Susanna Prat-Gonzalez
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose Apolo
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José María Tolosana
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lluís Mont
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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21
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Bertelsen L, Alarcón F, Andreasen L, Benito E, Olesen MS, Vejlstrup N, Mont L, Svendsen JH. Verification of threshold for image intensity ratio analyses of late gadolinium enhancement magnetic resonance imaging of left atrial fibrosis in 1.5T scans. Int J Cardiovasc Imaging 2019; 36:513-520. [PMID: 31748945 PMCID: PMC7080681 DOI: 10.1007/s10554-019-01728-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022]
Abstract
The use of cardiovascular magnetic resonance imaging left atrial late gadolinium enhancement (LA LGE) is increasing for fibrosis evaluation though the use is still limited to specialized centres due to complex image acquisition and lack of consensus on image analyses. Analysis of LA LGE with image intensity ratio (IIR) (pixel intensity of atrial wall normalized by blood pool intensity) provides an objective method to obtain quantitative data on atrial fibrosis. A threshold between healthy myocardium and fibrosis of 1.2 has previously been established in 3T scans. The aim of the study was to reaffirm this threshold in 1.5T scans. LA LGE was performed using a 1.5T magnetic resonance scanner on: 11 lone-AF patients, 11 age-matched healthy volunteers (aged 27-44) and 11 elderly patients without known history of AF but varying degrees of comorbidities. Mean values of IIR for all healthy volunteers +2SD were set as upper limit of normality and was reproduced to 1.21 and the original IIR-threshold of 1.20 was maintained. The degree of fibrosis in lone-AF patients [median 9.0% (IQR 3.9-12.0)] was higher than in healthy volunteers [2.8% (1.3-8.3)] and even higher in elderly non-AF [20.1% (10.2-35.8), p = 0.001]. The previously established IIR-threshold of 1.2 was reaffirmed in 1.5T LA LGE scans. Patients with lone AF presented with increased degrees of atrial fibrosis compared to healthy volunteers in the same age-range. Elderly patients with no history of AF showed significantly higher degrees of fibrosis compared to both groups with younger individuals.
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Affiliation(s)
- Litten Bertelsen
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Francisco Alarcón
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA) Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Andreasen
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Benito
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA) Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Niels Vejlstrup
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lluis Mont
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA) Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chubb H, Karim R, Mukherjee R, Williams SE, Whitaker J, Harrison J, Niederer SA, Staab W, Gill J, Schaeffter T, Wright M, O'Neill M, Razavi R. A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes. J Cardiovasc Electrophysiol 2019; 30:1894-1903. [DOI: 10.1111/jce.14111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Henry Chubb
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
| | - Rashed Karim
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
| | - Rahul Mukherjee
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
| | - Steven E. Williams
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
- Department of CardiologySt Thomas’ HospitalLondon UK
| | - John Whitaker
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
| | - James Harrison
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
- Department of CardiologySt Thomas’ HospitalLondon UK
| | - Steven A. Niederer
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
- Department of CardiologySt Thomas’ HospitalLondon UK
| | - Wieland Staab
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
| | - Jaspal Gill
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
| | - Matthew Wright
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
- Department of CardiologySt Thomas’ HospitalLondon UK
| | - Mark O'Neill
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
- Department of CardiologySt Thomas’ HospitalLondon UK
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondon UK
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23
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Wykretowicz M, Katulska K, Zwanzig M, Krauze T, Piskorski J, Guzik P, Wykretowicz A. Association of left atrial fibrosis with aortic excess pressure and white matter lesions. SCAND CARDIOVASC J 2019; 53:317-322. [DOI: 10.1080/14017431.2019.1645352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mateusz Wykretowicz
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Katulska
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Zwanzig
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Krauze
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Jaroslaw Piskorski
- Institute of Physics, University of Zielona Gora, Zielona Góra, Poland
- Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland
| | - Przemyslaw Guzik
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Wykretowicz
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
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24
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Ghannam M, Oral H. Mapping and Imaging in Non-paroxysmal AF. Arrhythm Electrophysiol Rev 2019; 8:202-209. [PMID: 31463058 PMCID: PMC6702463 DOI: 10.15420/aer.2019.18.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
Despite intense research efforts, maintenance of sinus rhythm in patients with non-paroxysmal AF remains challenging with suboptimal outcomes. A major limitation to the success of current ablation-based treatments is that our understanding of AF pathophysiology is incomplete. Advances in imaging and mapping tools have been reported to improve ablation outcomes. However, the role of these new approaches on the clinical care of patients with AF remains to be validated and better understood before wide adoption can occur. This article reviews the current techniques of imaging and mapping that can be applied in the management of patients with non-paroxysmal AF with a focus on their relevance to catheter ablation. Future applications and opportunities for new knowledge are also discussed.
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Affiliation(s)
- Michael Ghannam
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan Ann Arbor, MI, US
| | - Hakan Oral
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan Ann Arbor, MI, US
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25
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Benito EM, Alarcon F, Mont L. LGE-MRI Characterization of Left Atrial Fibrosis: a Tool to Establish Prognosis and Guide Atrial Fibrillation Ablation. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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26
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Bening C, Mazalu EA, Yaqub J, Alhussini K, Glanowski M, Kottmann T, Leyh R. Atrial contractility and fibrotic biomarkers are associated with atrial fibrillation after elective coronary artery bypass grafting. J Thorac Cardiovasc Surg 2019; 159:515-523. [PMID: 30929988 DOI: 10.1016/j.jtcvs.2019.02.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE New-onset postoperative atrial fibrillation is common after cardiac surgery. Less has been reported about the relationship among fibrosis, inflammation, calcium-induced left atrial and right atrial contractile forces, and postoperative atrial fibrillation. We sought to identify predictors of postoperative atrial fibrillation. METHODS From August 2016 to February 2018, we evaluated 229 patients who had preoperative sinus rhythm before elective primary coronary artery bypass grafting. Of 229 patients, 191 maintained sinus rhythm postoperatively, whereas 38 patients developed atrial fibrillation. Preoperative tissue inhibitor of metalloproteinase-1, pentraxin-3, matrix metallopeptidase-9, galectin-3, high-sensitivity C-reactive protein, growth differentiation factor 15, and transforming growth factor-ß were measured. Clinical and echocardiographic findings (tricuspid annular plane systolic excursion for right heart function) and calcium-induced force measurements from left atrial and right atrial-derived skinned myocardial fibers were recorded. RESULTS Patients with atrial fibrillation were older (P = .001), had enlarged left atrial (P = .0001) and right atrial areas (P = .0001), and had decreased tricuspid annular plane systolic excursion (P = .001). Levels of matrix metallopeptidase-9 and pentraxin-3 were decreased (P < .05), whereas growth differentiation factor 15 was increased (P = .001). We detected lower left atrial force values at calcium-induced force measurements 5.5 (P < .05), 5.4 (P < .01), and 5.3 to 4.52 (P = .0001) and right atrial force values at calcium-induced force measurements 5.0 to 4.52 (P < .05) in patients with postoperative atrial fibrillation. Multivariable analysis showed that advanced age (P = .033), decreased left atrial force value at calcium-induced force measurement of 5.5 (P = .033), enlarged left atrial (P = .013) and right atrial (P = .081) areas, and reduced tricuspid annular plane systolic excursion (P = .010) independently predicted postoperative atrial fibrillation. CONCLUSIONS Advanced age, decreased left atrial force value at calcium-induced force measurement of 5.5, enlarged left atrial and right atrial areas, and reduced tricuspid annular plane systolic excursion were identified as independent predictors for postoperative atrial fibrillation.
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Affiliation(s)
- Constanze Bening
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Centre Würzburg, University of Wuerzburg, Wuerzburg, Germany.
| | - Elena-Aura Mazalu
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Jonathan Yaqub
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Khaled Alhussini
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Michal Glanowski
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany
| | | | - Rainer Leyh
- Department of Thoracic and Cardiovascular Surgery, University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Centre Würzburg, University of Wuerzburg, Wuerzburg, Germany
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Catheter ablation in elderly patients: a review of current studies and pending questions. Curr Opin Cardiol 2018; 34:29-34. [PMID: 30444764 DOI: 10.1097/hco.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Catheter ablations are established treatment options for cardiac arrhythmias. Despite the fact that they are increasingly performed in elderly patients, publications focusing on procedural safety and success concerning this patient subgroup are sparse. The purpose of this review is to inform about current and upcoming studies regarding catheter ablations in the elderly. RECENT FINDINGS The overall pattern of available studies is indistinct because of varying age limits and scant patient populations. Most studies do not identify advanced patient age as a promoting factor for peri-procedural complications and recurrence rates. There are a few upcoming publications with regards to catheter ablations in the elderly, some of which might produce new insight. SUMMARY The results at hand might implicate, that in most cases individual patient health could be decisive instead of mere patient age to promise well-tolerated and effective catheter ablation in aged patients. Nevertheless, further studies with larger patient populations are needed to clarify the role of catheter ablation in aged patients.
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New Insights Into the Use of Cardiac Magnetic Resonance Imaging to Guide Decision Making in Atrial Fibrillation Management. Can J Cardiol 2018; 34:1461-1470. [DOI: 10.1016/j.cjca.2018.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 12/13/2022] Open
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Schumacher K, Büttner P, Kornej J. Letter to the editor regarding the paper "Impact of left atrial volume, sphericity and fibrosis on the outcome of catheter ablation for atrial fibrillation". J Cardiovasc Electrophysiol 2018; 29:E13-E14. [PMID: 29777553 DOI: 10.1111/jce.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Petra Büttner
- Department of Electrophysiology, Heart Center, Leipzig, Germany
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center, Leipzig, Germany
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30
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den Uijl DW, Mont L. Response to the letter to the editor on "Impact of left atrial volume, sphericity, and fibrosis on the outcome of catheter ablation for atrial fibrillation". J Cardiovasc Electrophysiol 2018; 29:E15. [PMID: 29777558 DOI: 10.1111/jce.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Dennis W den Uijl
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lluís Mont
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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