1
|
Gottlieb LA, Al Jefairi N, El Hamrani D, Naulin J, Lamy J, Kachenoura N, Constantin M, Quesson B, Cochet H, Coronel R, Dekker LR. Reduction in left atrial and pulmonary vein dimensions after ablation therapy is mediated by scar. IJC HEART & VASCULATURE 2021; 37:100894. [PMID: 34746362 PMCID: PMC8554268 DOI: 10.1016/j.ijcha.2021.100894] [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: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ablative pulmonary vein isolation (PVI) decreases pulmonary vein (PV) and left atrial (LA) dimensions in atrial fibrillation (AF) patients. These changes are attributed to reverse structural remodeling following sinus rhythm restoration but evidence is lacking. We hypothesized that the downsizing is directly caused by the ablative energy and subsequent scar formation. METHODS We studied cardiac magnetic resonance imaging in 21 paroxysmal AF patients before and 3 months after successful PVI and in healthy sheep (n = 12) before and after PVI of the right PV only. RESULTS PVI decreased the PV diameter in patients and sheep by 11.0(10.3) and 9.2(11.0)%, (p < 0.001 and p = 0.020), respectively. The control left PV in sheep were unchanged. A linear correlation existed between the extent of PV scar and PVI-induced decrease in PV diameter in patients.After PVI, the LA volume decreased (103(38) vs. 92(31)ml, pre- vs. post-ablation, respectively, p = 0.006), while the right atrial (RA) volume was unchanged in patients. A decrease in active emptying fraction after ablation (26.5(10.7) vs. 21.8(10.6)%, pre- vs. post-ablation, p = 0.031) was associated with reduced contractility of the PV walls (p = 0.004). The contractility of the LA walls was unaltered (p = 0.749). CONCLUSION The ablation-induced PV diameter reduction was similar in patients with AF and healthy sheep without AF and was associated with PV scar extent. The volume only decreased in LA and not RA after PVI, and wall contractility decreased only in ablated sites. Therefore, the PVI-induced atrial downsizing is caused by the ablative energy and subsequent scar formation.
Collapse
Affiliation(s)
- Lisa A. Gottlieb
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
- Department of Experimental Cardiology, AUMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Nora Al Jefairi
- Department of Cardiac Pacing and Electrophysiology, University Hospital, Bordeaux, Pessac, France
| | - Dounia El Hamrani
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Jérôme Naulin
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, USA
| | - Nadjia Kachenoura
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, Paris, France
| | - Marion Constantin
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Bruno Quesson
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Ruben Coronel
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
- Department of Experimental Cardiology, AUMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Lukas R.C. Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands
- Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands
| |
Collapse
|
2
|
Mehra N, Kowlgi GN, Deshmukh AJ. Predictors of Outcomes in Patients with Atrial Fibrillation: What Can Be Used Now and What Hope Is in the Future. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00645-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
3
|
Johner N, Namdar M, Shah DC. Individualised Approaches for Catheter Ablation of AF: Patient Selection and Procedural Endpoints. Arrhythm Electrophysiol Rev 2019; 8:184-190. [PMID: 31463056 PMCID: PMC6702473 DOI: 10.15420/aer.2019.33.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but studies have reported improved efficacy with high rates of repeat procedures. Because of the large interindividual variability in the underlying electrical and anatomical substrate, achieving optimal outcomes requires an individualised approach. This includes optimal candidate selection as well as defined ablation strategies with objective procedure endpoints beyond PVI. Candidate selection is traditionally based on coarse and sometimes arbitrary clinical stratification such as AF type, but finer predictors of treatment efficacy including biomarkers, advanced imaging and electrocardiographic parameters have shown promise. Numerous ancillary ablation strategies beyond PVI have been investigated, but the absence of a clear mechanistic and evidence-based endpoint, unlike in other arrhythmias, has remained a universal limitation. Potential endpoints include functional ones such as AF termination or non-inducibility and substrate-based endpoints such as isolation of low-voltage areas. This review summarises the relevant literature and proposes guidance for clinical practice and future research.
Collapse
Affiliation(s)
- Nicolas Johner
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
| | - Mehdi Namdar
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
| | - Dipen C Shah
- Cardiology Division, University Hospital of Geneva Geneva, Switzerland
| |
Collapse
|
4
|
Johner N, Shah DC, Giannakopoulos G, Girardet A, Namdar M. Evolution of post–pulmonary vein isolation atrial fibrillation inducibility at redo ablation: Electrophysiological evidence of extra–pulmonary vein substrate progression. Heart Rhythm 2019; 16:1160-1166. [DOI: 10.1016/j.hrthm.2019.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 12/24/2022]
|
5
|
Monno K, Okumura Y, Saito Y, Aizawa Y, Nagashima K, Arai M, Watanabe R, Wakamatsu Y, Otsuka N, Yoda S, Hiro T, Watanabe I, Hirayama A. Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation. J Arrhythm 2018; 34:607-616. [PMID: 30555604 PMCID: PMC6288560 DOI: 10.1002/joa3.12124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Metabolic syndrome/epicardial adipose tissue (EAT) plays an important role in atrial fibrillation (AF). Although reverse atrial remodeling (RAR) often occurs after AF ablation, the effects of EAT on RAR remain unknown. METHODS Study subjects were 104 patients in whom transthoracic echocardiography (TTE) was performed before AF ablation and 3, 6, and 12 months afterward. EAT was assessed in terms of its thickness adjacent to the right ventricular anterior wall in the TTE parasternal view. RAR was defined as >10% reduction in the left atrial volume (LAV) index by the 3-month follow-up examination. RESULTS Postablation RAR occurred in 57/104 (55%) patients. RAR absence was associated with a relatively thick EAT (4.92 ± 1.65 vs. 3.92 ± 1.17 mm, P = 0.0005), small LAV index (24.6 ± 7.5 vs. 28.8 ± 10.6 mL/m2, P = 0.0233), and metabolic syndrome (62% vs. 28%, P = 0.0006). Metabolic syndrome and EAT were shown to be independent predictors of RAR absence. Thick EAT was significantly associated with AF recurrence after ablation (5.05 ± 2.19 mm vs. 4.17 ± 1.16 mm for no AF recurrence group, P = 0.0116), but metabolic syndrome was not (48% vs. 42%, P = 0.6189). Despite no change in body weight, EAT thickness decreased significantly by 12 months in patients without AF recurrence (4.17 ± 1.16 vs. 3.65 ± 1.16 mm, P < 0.0001). CONCLUSIONS EAT and metabolic syndrome appear to be strongly associated with RAR absence, but only the thick EAT was significantly associated with the postablation AF recurrence. Our findings, especially the thinning of EAT, suggest that thick EAT lead to AF vulnerability but that EAT reduction favorably affects ablation outcome.
Collapse
Affiliation(s)
- Koyuru Monno
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Yuki Saito
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Yoshihiro Aizawa
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Masaru Arai
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Naoto Otsuka
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Shunichi Yoda
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Takafumi Hiro
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Ichiro Watanabe
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Atsushi Hirayama
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| |
Collapse
|
6
|
Left atrial function in obese and non-obese patients undergoing percutaneous pulmonary vein isolation. Heart Vessels 2018; 34:343-351. [PMID: 30143884 PMCID: PMC6510870 DOI: 10.1007/s00380-018-1243-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022]
Abstract
Obesity constitutes a risk factor for atrial fibrillation (AF) and modifies the efficacy of invasive AF treatment. Left atrial (LA) global longitudinal strain (GLS), which is measured using speckle-tracking echocardiography (STE), is one of the new methods that are helpful in evaluating the function of LA. The aim of the study was to evaluate LA function in obese and non-obese patients that were undergoing percutaneous pulmonary vein isolation (PVI) before and 6 months after the procedure. 89 patients (F/M: 31/58; mean age: 55.8 ± 9.8 years) with paroxysmal or persistent symptomatic AF that had been qualified for percutaneous PVI were prospectively enrolled in the study. Body mass index (BMI) constituted as a discriminating factor for the study groups: obese group: BMI ≥ 30 kg/m2 (29 patients, F/M: 13/16, mean age: 55.13 ± 10.1 years) and non-obese group BMI < 30 kg/m2 (60 patients, F/M: 18/42, mean age: 57.17 ± 9.0 years). Transthoracic echocardiography (TTE) with LA GLS and segmental longitudinal strain were analysed 1 day before and 6 months after PVI. PVI efficacy was evaluated 6 months after PVI via a seven-day Holter monitoring. Baseline analysis revealed significantly lower two-chamber (2-Ch) LA GLS in the obese patients compared to the non-obese subjects (− 10.55 ± 3.7 vs − 13.11 ± 5.1, p = 0.004). Segmental strain analysis showed no significant differences between the groups. The data that was obtained 6 months after PVI showed a significantly lower 4-Ch LA GLS in the obese patients compared to the non-obese subjects (− 11.04 ± 5.0 vs − 13.91 ± 4.2, p = 0.02), which was accompanied by a significantly lower segmental 4-Ch LA function in the obese patients (med-sept: − 11.66 ± 11.2 vs − 15.97 ± 5.3, p = 0.04; api-sept: − 9.04 ± 6.3 vs − 13.62 ± 6.5, p < 0.001; api-lat: − 7.62 ± 4.0 vs − 13.62 ± 6.5, p < 0.001; med-lat: −9.31 + − 7.9 vs − 15.04 + − 6.3, p = 0.003, global: − 11.04 + − 5.0 vs − 13.91 + − 4.2, p = 0.02). PVI efficacy was confirmed in 52 (58.4%) patients and was similar in both groups. Comparison of the baseline and 6-month strain revealed no differences in LA GLS in either group. Differences in LA GLS before and after the procedure (delta LA GLS) were not obesity dependent. Apical-septal and apical-lateral strain in the obese group, which were measured in 4-Ch view, were significantly lower after the procedure compared to the baseline (p < 0.001). Obese patients with paroxysmal AF were characterised by impaired LA GLS, which is persistent and was accompanied by segmental dysfunction after PVI at the 6-month follow-up. PVI efficacy was comparable between the obese and non-obese patients.
Collapse
|
7
|
Pedrote A, Acosta J, Jáuregui-Garrido B, Frutos-López M, Arana-Rueda E. Paroxysmal atrial fibrillation ablation: Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions. World J Cardiol 2017; 9:230-240. [PMID: 28400919 PMCID: PMC5368672 DOI: 10.4330/wjc.v9.i3.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Pulmonary vein isolation by point-by-point radiofrequency catheter ablation constitutes the cornerstone of catheter ablation strategies for the treatment of atrial fibrillation. However, despite advances in pulmonary vein isolation ablation strategies, long-term success rates after ablation remain suboptimal, which highlights the need to develop techniques to achieve more durable lesions. Strategies proposed to improve the durability of pulmonary vein isolation can be divided into two groups: Those addressed to improving the quality of the lesion and those that optimize the detection of acute PV reconnection during the ablation procedure. This manuscript reviews the role and potential benefits of these techniques according to current clinical evidence.
Collapse
|
8
|
O'Neill L, Harrison J, O'Neill M, Williams SE. Clinical, electrophysiological and imaging predictors of atrial fibrillation ablation outcome. Expert Rev Cardiovasc Ther 2017; 15:289-305. [PMID: 28267401 DOI: 10.1080/14779072.2017.1303378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Significant technological advances for catheter ablation of atrial fibrillation (AF) have occurred over the last decade, with a consequent increase in numbers of patients referred for AF ablation worldwide. Despite this, long-term success rates, particularly in those with persistent AF, remain modest. The patient population presenting for AF ablation are heterogeneous with regard to age, type of AF and presence of associated cardiovascular disease. Improved understanding of factors predicting response to AF ablation may therefore help to improve patient selection for ablation procedures. Areas covered: This review outlines the clinical, electrophysiological and imaging predictors of response to radiofrequency ablation for AF in contemporary practice. Recently developed scoring systems incorporating these parameters are examined, as are factors identified thus far which may predict the outcome of cryoballoon ablation. Expert commentary: Traditional clinical factors associated with ablation outcomes serve as surrogates rather than direct measures of the underlying arrhythmia substrate. An improved understanding of this substrate could improve the prediction of response to radiofrequency ablation. Continued development of methods for characterising the arrhythmia substrate, including atrial cardiac magnetic resonance imaging and invasive voltage mapping, may inform patient risk assessment and help guide selection for catheter ablation on an increasingly individualistic basis.
Collapse
Affiliation(s)
- Louisa O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - James Harrison
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Mark O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Steven E Williams
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| |
Collapse
|
9
|
Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Selección de temas de actualidad en arritmias y estimulación cardiaca 2015. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Cardiac Arrhythmias and Pacing 2015: A Selection of Topical Issues. ACTA ACUST UNITED AC 2016; 69:167-75. [PMID: 26778594 DOI: 10.1016/j.rec.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Rafael Peinado
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Maite Izquierdo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eduardo Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Maria Robledo
- Sección de Arritmias, Servicio de Cardiología, Hospital Universitario Araba, Vitoria, Álava, Spain
| | - Miguel Angel Arias
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Juan Jiménez-Jáimez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Moisés Rodríguez-Mañero
- Unidad de Arritmias, Departamento de Cardiología, Complejo Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Javier Chimeno
- Sección de Cardiología, Hospital Virgen de la Concha, Zamora, Spain
| |
Collapse
|