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van der Heijden CAJ, Adriaans BP, van Kuijk SMJ, Luermans JGLM, Chaldoupi SM, Maessen JG, Bidar E, Maesen B. Left atrial function of patients with atrial fibrillation undergoing thoracoscopic hybrid ablation. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae061. [PMID: 38569919 PMCID: PMC11043019 DOI: 10.1093/icvts/ivae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Thoracoscopic hybrid ablation is an effective and safe rhythm control strategy for patients with complex forms of atrial fibrillation. Its effect on left atrial function has not yet been studied. METHODS In a retrospective single-centre analysis of patients undergoing thoracoscopic hybrid ablation, the left atrial emptying fraction was calculated using the biplane modified Simpson method in the apical 2- and 4-chamber views on transthoracic echocardiography. Left atrial strain (reservoir, conduction and contractility) was quantified using dedicated software. RESULTS Sixty-seven patients were included (mean age 64 years, long-standing persistent atrial fibrillation in 69%, median atrial fibrillation history duration 64 months). At baseline, left atrial function and contractility were poor. The reservoir and contractile strain improved postprocedure compared to baseline [15 (standard deviation (SD): 8) and 17 (SD: 6); P = 0.013; 3 (SD: 5) and 4 (SD: 4), P = 0.008], whereas the left atrial volume indexed to the body surface area was reduced [51 ml/m2 (SD: 14) and 47 ml/m2 (SD: 18), P = 0.0024]. In patients with preoperative (long-standing) persistent atrial fibrillation and in patients with rhythm restoration, improvements in the emptying fraction, (reservoir and contractile) strain and the left ventricular ejection fraction were observed, whereas the left atrial volume decreased (P < 0.05). CONCLUSIONS In this cohort of patients with severely diseased left atria, improvement in left atrial contractility and in the emptying fraction after thoracoscopic hybrid ablation for atrial fibrillation in patients with persistent atrial fibrillation is mainly due to rhythm restoration. Interestingly, the procedure itself also results in improved left atrial reservoir strain and reversed left atrial remodelling by reducing left atrial volume.
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Affiliation(s)
| | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Sevasti-Marisevi Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
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Ozkan E, Elcik D, Barutcu S, Kelesoglu S, Alp ME, Ozan R, Capar G, Turkmen O, Cinier G, Polat V, Inanc MT, Kepez A, Akgun T. Inflammatory Markers as Predictors of Atrial Fibrillation Recurrence: Exploring the C-Reactive Protein to Albumin Ratio in Cryoablation Patients. J Clin Med 2023; 12:6313. [PMID: 37834958 PMCID: PMC10573371 DOI: 10.3390/jcm12196313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with hemodynamic disruptions and thromboembolic events. While antiarrhythmic drugs are often recommended as the initial treatment, catheter ablation has emerged as a viable alternative. However, the recurrence of AF following ablation remains a challenge, and there is growing interest in exploring inflammatory markers as predictors of recurrence. METHODS This retrospective, cross-sectional analysis included 249 patients who underwent cryoablation for paroxysmal AF. The relationship between the 'C-reactive protein (CRP) to albumin ratio (CAR)' and AF recurrence was examined. RESULTS Two hundred and forty-nine patients with paroxysmal non-valvular atrial fibrillation were included. They were divided into two groups: those without recurrence (Group 1) and those with recurrence (Group 2). Significant differences were observed in age (57.2 ± 9.9 vs. 62.5 ± 8.4, p = 0.001) and left atrial size (4.0 ± 0.5 vs. 4.2 ± 0.7, p = 0.001) between the two groups. In blood parameters, significant differences were found in CRP (5.2 ± 1.3 vs. 9.4 ± 2.8, p < 0.001) and neutrophil counts (5.1 ± 2.2 vs. 6.7 ± 3.6, p = 0.001). In univariate regression analysis, age (OR: 1.058, CI: 1.024-1.093, p = 0.001), WBC count (OR: 1.201, CI: 1.092-1.322, p < 0.001), neutrophil count (OR: 1.239, CI: 1.114-1.378, p = 0.001), CAR (OR: 1.409, CI: 1.183-1.678, p < 0.001), and left atrial diameter (OR: 0.968, CI: 0.948-0.989, p = 0.002) showed significant associations with AF recurrence. CONCLUSIONS Inflammation plays a crucial role in the initiation and progression of AF. This study demonstrated that along with age, the CAR can serve as an independent predictor of AF recurrence following cryoablation.
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Affiliation(s)
- Eyup Ozkan
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Deniz Elcik
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Suleyman Barutcu
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Saban Kelesoglu
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Murat Erdem Alp
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Ramazan Ozan
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Gazi Capar
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Omer Turkmen
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Goksel Cinier
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Veli Polat
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
| | - Mehmet Tugrul Inanc
- Faculty of Medicine, Erciyes University, 38280 Kayseri, Turkey; (D.E.); (S.K.); (R.O.); (M.T.I.)
| | - Alper Kepez
- Department of Cardiology, School of Medicine, Marmara University, 34722 Istanbul, Turkey;
| | - Taylan Akgun
- Basaksehir Cam ve Sakura City Hospital, 34480 Istanbul, Turkey; (S.B.); (M.E.A.); (G.C.); (O.T.); (G.C.); (V.P.); (T.A.)
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Wesselink R, Vroomen M, Overeinder I, Neefs J, van den Berg NWE, Meulendijks ER, Piersma FR, Al-Shama RFM, de Vries TAC, Verstraelen TE, Luermans J, Maesen B, de Asmundis C, Chierchia GB, La Meir M, Pison L, van Boven WJP, Driessen AHG, de Groot JR. A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:417-426. [PMID: 36155846 DOI: 10.1016/j.rec.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/09/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Recent observations suggest that patients with a previous failed catheter ablation have an increased risk of atrial fibrillation (AF) recurrence after subsequent thoracoscopic AF ablation. We assessed the risk of AF recurrence in patients with a previous failed catheter ablation undergoing thoracoscopic ablation. METHODS We included patients from 3 medical centers. To correct for potential heterogeneity, we performed propensity matching to compare AF freedom (freedom from any atrial tachyarrhythmia> 30 s during 1-year follow-up). Left atrial appendage tissue was analyzed for collagen distribution. RESULTS A total of 705 patients were included, and 183 had a previous failed catheter ablation. These patients had fewer risk factors for AF recurrence than ablation naïve controls: smaller indexed left atrial volume (40.9± 12.5 vs 43.0±12.5 mL/m2, P=.048), less congestive heart failure (1.5% vs 8.9%, P=.001), and less persistent AF (52.2% vs 60.3%, P=.067). However, AF history duration was longer in patients with a previous failed catheter ablation (6.5 [4-10.5] vs 4 [2-8] years; P<.001). In propensity matched analysis, patients with a failed catheter ablation were at a 68% higher AF recurrence risk (OR, 1.68; 95%CI, 1.20-2.15; P=.034). AF freedom was 61.1% in patients with a previous failed catheter ablation vs 72.5% in ablation naïve matched controls. On histology of the left atrial appendage (n=198), patients with a failed catheter ablation had a higher density of collagen fibers. CONCLUSIONS Patients with a prior failed catheter ablation had fewer risk factors for AF recurrence but more frequently had AF recurrence after thoracoscopic AF ablation than ablation naïve patients. This may in part be explained by more progressed, subclinical, atrial fibrosis formation.
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Affiliation(s)
- Robin Wesselink
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mindy Vroomen
- Department of Cardiac Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jolien Neefs
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Nicoline W E van den Berg
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Eva R Meulendijks
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Femke R Piersma
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rushd F M Al-Shama
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tim A C de Vries
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tom E Verstraelen
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Justin Luermans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bart Maesen
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark La Meir
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Cardiothoracic Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Laurent Pison
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Wim Jan P van Boven
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Antoine H G Driessen
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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Wesselink R, Vroomen M, Overeinder I, Neefs J, van den Berg NW, Meulendijks ER, Piersma FR, Al-Shama RF, de Vries TA, Verstraelen TE, Luermans J, Maesen B, de Asmundis C, Chierchia GB, La Meir M, Pison L, van Boven WJP, Driessen AH, de Groot JR. El fracaso de la ablación por catéter de la fibrilación auricular se asocia con mayor remodelado y menos eficacia de una posterior ablación toracoscópica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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5
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Kawaji T, Yamgami S, Shizuta S, Aizawa T, Kato M, Yokomatsu T, Miki S, Ono K, Kimura T. Relation of a Filling Defect of Left Atrial Appendage by Contrast Computed Tomography Image With Subsequent Clinical Events in Patients With Atrial Fibrillation Receiving Catheter Ablation Procedures. Am J Cardiol 2022; 180:29-36. [PMID: 35863941 DOI: 10.1016/j.amjcard.2022.06.009] [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] [Received: 02/02/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
Filling defect (FD) in left atrial appendage (LAA) is commonly observed in contrast computed tomography (CT) among patients with atrial fibrillation (AF), although its prognostic impact has not been well explored. We enrolled 1,019 consecutive patients who underwent AF ablation with baseline contrast CT images. FD in LAA was graded into 3 groups: grade 0 for complete filling (79.7%), grade 1 for incomplete filling (12.6%), and grade 2 for complete FD (7.8%). We evaluated the impact of the FD grade on the long-term clinical outcomes during the mean follow-up of 4.4 ± 2.0 years. Patients with grade 2 FD had higher prevalence of nonparoxysmal AF, higher brain natriuretic peptide level, and larger left atrial volume than those with grade 0 or 1 FD. The 5-year cumulative incidence of recurrent atrial tachyarrhythmias was higher in patients with grade 2 FD than those with grade 0 or 1 FD (74.0% vs 38.8% and 62.1%, log-rank p <0.001). The 5-year cumulative incidence of major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, heart failure hospitalization, and ischemic stroke, was also significantly higher in patients with grade 2 FD (19.4% vs 5.6% and 9.5%, log-rank p <0.001). Follow-up CT images acquired in 87.1% of patients at median interval of 98 days showed significantly decreased FD (grade 1 in 4.5% and grade 2 in 2.1%, p <0.001). The residual grade 2 FD at follow-up was associated with significantly higher risk for subsequent MACEs. In conclusion, among patients with AF receiving catheter ablation, severe FD in LAA in contrast CT was associated with higher incidence of arrhythmia recurrence and MACEs during follow-up.
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Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Yamgami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Liu HT, Lee HL, Chou CC. From Left Atrial Dimension to Curved M-Mode Speckle-Tracking Images: Role of Echocardiography in Evaluating Patients with Atrial Fibrillation. Rev Cardiovasc Med 2022; 23:171. [PMID: 39077610 PMCID: PMC11273969 DOI: 10.31083/j.rcm2305171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 07/31/2024] Open
Abstract
Left atrial (LA) enlargement and dysfunction increase the risk of atrial fibrillation (AF). Traditional echocardiographic evaluation of the left atrium has been limited to dimensional and semi-quantification measurement of the atrial component of ventricular filling, with routine measurement of LA function not yet implemented. However, functional parameters, such as LA emptying fraction (LAEF), may be more sensitive markers for detecting AF-related changes than LA enlargement. Speckle-tracking echocardiography has proven to be a feasible and reproducible technology for the direct evaluation of LA function. The clinical application, advantages, and limitations of LA strain and strain rate need to be fully understood. Furthermore, the prognostic value and utility of this technique in making therapeutic decisions for patients with AF need further elucidation. Deep learning neural networks have been successfully adapted to specific tasks in echocardiographic image analysis, and fully automated measurements based on artificial intelligence could facilitate the clinical diagnostic use of LA speckle-tracking images for classification of AF ablation outcome. This review describes the fundamental concepts and a brief overview of the prognostic utility of LA size, LAEF, LA strain and strain rate analyses, and the clinical implications of the use of these measures.
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Affiliation(s)
- Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, 33304 Taoyuan, Taiwan
| | - Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei branch, 10507 Taipei, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, 33304 Taoyuan, Taiwan
- School of Medicine, Chang Gung University College of Medicine, 33302 Taoyuan, Taiwan
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Effect of catheter ablation on the hemodynamics of the left atrium. J Interv Card Electrophysiol 2022; 65:83-96. [DOI: 10.1007/s10840-022-01191-3] [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: 12/27/2021] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
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8
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Cao M, Guo H, Zhao X, Li X, Sun C. Refinement of CHADS2 and CHA2DS2-VASc scores predict left atrial thrombus or spontaneous echo contrast in nonvalvular atrial fibrillation patients. J Int Med Res 2022; 50:3000605221074520. [PMID: 35196885 PMCID: PMC8883313 DOI: 10.1177/03000605221074520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the risk factors of left atrial thrombus (LAT)/spontaneous echo contrast (SEC) in patients with nonvalvular atrial fibrillation (AF). Methods This retrospective study analysed the data from consecutive patients with nonvalvular AF that underwent transoesophageal echocardiography. Logistic regression analysis was performed to identify risk factors of LAT/SEC. Receiver operating characteristic curve analysis was undertaken compare the new scales with CHADS2 and CHA2DS2-VASc scores. Results A total of 558 patients with AF were included in the study. LAT/SEC was detected in 137 (24.6%) patients. The independent risk factors of LAT/SEC beyond CHADS2 or CHA2DS2-VASc scores included non-paroxysmal AF and left atrial diameter >37.5 mm. These two variables were added into the CHADS2 or CHA2DS2-VASc score to build new scales. Areas under the curve for the new scales based on CHADS2 and CHA2DS2-VASc scores were significantly higher than the CHADS2 or CHA2DS2-VASc score both in the overall study cohort and in patients at a high risk of thromboembolism. Conclusions Non-paroxysmal AF and increased left atrial diameter beyond the CHADS2 or CHA2DS2-VASc score were independent risk factors of LAT/SEC and may help to improve the current risk stratification, especially for patients with nonvalvular AF at a high risk of thromboembolism.
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Affiliation(s)
- Miaomiao Cao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Huihui Guo
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiao Zhao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiyang Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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9
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Current evidence on the safety and efficacy of combined atrial fibrillation ablation and left atrial appendage closure. Curr Opin Cardiol 2022; 37:74-79. [PMID: 34857717 DOI: 10.1097/hco.0000000000000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Combined atrial fibrillation (AF) ablation and left atrial (LA) appendage (LAA) closure (LAAC) has been practiced for management of both the symptoms and the high stroke risk of AF. The purpose of this review is to review recent evidence regarding the combined procedure. RECENT FINDINGS Newly acquired long-term data of combined AF ablation and LAAC supplied satisfactory evidence on the safety and efficacy of the combined procedure. Studies also showed LA structural remodeling following combined procedure was mainly affected by sinus rhythm status post catheter ablation, not by LAAC. A cost-effectiveness study revealed that combined procedure was a cost-effective therapeutic option in symptomatic AF patients with high stroke and bleeding risk. Due to recent evidence of high incidences of LAA thrombus formation after LAA electrical isolation (LAAEI) and benefit of LAAC after LAAEI, an extended combined procedure of standard AF ablation plus LAAEI and LAAC was considered as a potential therapeutic option for persistent AF patients with high stroke risk. SUMMARY In conclusion, combined AF ablation and LAAC serve as a promising option for patients with symptomatic AF and high risk of stroke and/or bleeding.
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10
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Buffle E, Johner N, Namdar M, Shah D. The significance of pulmonary veins isolation radiofrequency time and the evolution of left atrium volume on a twelve-year observational follow-up of paroxysmal atrial fibrillation patients. Indian Heart J 2022; 74:120-126. [PMID: 35101393 PMCID: PMC9039693 DOI: 10.1016/j.ihj.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/17/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
Aims Pulmonary vein isolation (PVI) is the treatment of choice of paroxysmal atrial fibrillation (PAF). However, radiofrequency delivery at extra-PV sites may be additionally required. We compared clinical and procedural characteristics of patients undergoing PVI alone versus adjunctive extra-PV substrate modification, at first procedure and repeat procedures for AF recurrence. Methods 587 patients with PAF undergoing radiofrequency (RF) ablation were retrospectively included. Extra-PV ablation was performed in case of sustained AF despite PVI, or at re-do procedures without PV conduction recovery. Demographic, clinical and electrophysiological predictors of survival without re-intervention were analysed in patients’ groups having undergone one (G1), two (G2) or three or more procedures (G3). Results At baseline procedure, PV RF ablation time was shorter in G1 compared to G2/G3 whereas extra-PV RF ablation time was greater in G3 compared to G1. The proportion of patients requiring PV re-isolation decreased with repeat procedures. Smaller LA before procedure 1 (p1) or p2 was associated with PV reconnection at p2. Conversely larger LA before p1 was associated with extra-PV substrate modification at p2. Late re-do procedure timing (>1yr) was associated with increasing LA volume. Only longer PV and total RF time predicted poorer survival free from AF without re-intervention. Conclusion Longer PV RF time predicted requirement for re-ablation during follow-up. Smaller LA size predicted an increased probability of PV reconnection and decreased extra-PV substrate modification at p2. LA size decreased in patients undergoing early re-intervention, whereas it increased in patients undergoing re-intervention later on suggesting ongoing remodelling or progression.
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Charitakis E, OKarlsson L, Carlhäll CJ, Liuba I, Jönsson AH, Walfridsson H, Alehagen U. Endocrine and Mechanical Cardiacfunction Four Months after Radiofrequency Ablation of Atrialfibrillation. J Atr Fibrillation 2021; 14:20200454. [PMID: 34950357 DOI: 10.4022/jafib.20200454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/17/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022]
Abstract
Background Radiofrequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded.We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. Methods In total 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP)were measured. The maximum LAvolume (LAVmax),the LAejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured usingtransthoracic echocardiography. The measurements were performed before and 4-months after the intervention. Results 87 patients had a recurrence during a mean follow-up of 143±36 days.NT-proBNPand MR-proANPdecreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA.The LAVmax decreased significantly, whereasthe PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. Conclusions Despite extensiveablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAVmax was reduced, and the LA strain improved significantly.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars OKarlsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Department of Clinical physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Division of Cardiovascular Medicine and CMIV, Linköping University, Linköping, Sweden
| | - Ioan Liuba
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Håkan Walfridsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
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12
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Ariyaratnam JP, Elliott AD, Mishima RS, Gallagher C, Lau DH, Sanders P. Heart failure with preserved ejection fraction: An alternative paradigm to explain the clinical implications of atrial fibrillation. Heart Rhythm O2 2021; 2:771-783. [PMID: 34988529 PMCID: PMC8710629 DOI: 10.1016/j.hroo.2021.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Atrial fibrillation (AF) is associated with exercise intolerance, stroke, and all-cause mortality. However, whether this can be solely attributable to the arrhythmia itself or alternative mechanisms remains controversial. Heart failure with preserved ejection (HFpEF) commonly coexists with AF and may contribute to the poor outcomes associated with AF. Indeed, several invasive hemodynamic studies have confirmed that patients with AF are at increased risk of underlying HFpEF and that the presence of HFpEF may have important prognostic implications in these patients. Mechanistically, AF and HFpEF are closely linked. Both conditions are driven by the presence of common cardiovascular risk factors and are associated with left atrial (LA) myopathy, characterized by mechanical and electrical dysfunction. Progressive worsening of this left atrial (LA) myopathy is associated with both increased AF burden and worsening HFpEF. In addition, there is growing evidence to suggest that worsening LA myopathy is associated with poorer outcomes in both conditions and that reversal of the LA myopathy could improve outcomes. In this review article, we will present the epidemiologic and mechanistic evidence underlying the common coexistence of AF and HFpEF, discuss the importance of a progressive LA myopathy in the pathogenesis of both conditions, and review the evidence from important invasive hemodynamic studies. Finally, we will review the prognostic implications of HFpEF in patients with AF and discuss the relative merits of AF burden reduction vs HFpEF reduction in improving outcomes of patients with AF and HFpEF.
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Affiliation(s)
- Jonathan P Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo S Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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13
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Kawakami H, Inoue K, Nagai T, Fujii A, Sasaki Y, Shikano Y, Sakuoka N, Miyazaki M, Takasuka Y, Ikeda S, Yamaguchi O. Persistence of left atrial abnormalities despite left atrial volume normalization after successful ablation of atrial fibrillation. J Arrhythm 2021; 37:1318-1329. [PMID: 34621431 PMCID: PMC8485788 DOI: 10.1002/joa3.12624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Left atrial volume index (LAVI) of >34 mL/m2 is the cutoff value for identifying an enlarged left atrium. The definition of left atrial (LA) reverse remodeling after atrial fibrillation (AF) ablation is undetermined. We hypothesized that patients with LA dilatation who achieve normal LA volume (LAVI<34 mL/m2) after AF ablation have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume can also achieve normal LA function with AF ablation. METHODS We enrolled 140 AF patients with baseline LAVI of ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 hour and at 1 year after the procedure. To define the normal range of LA function, age- and sex-matched controls without a history of AF were also enrolled. RESULTS After restoration of sinus rhythm, LA structural and functional parameters significantly improved, and 75 patients (54%) had normal LA volume. During a median follow-up of 44 (31-61) months, 32 patients (23%) experienced a late recurrence of AF (AF recurrence >1 year). Patients who achieved normal LA volume after AF ablation had fewer late recurrences than those who did not (P < .01). However, LA abnormalities, especially LA dysfunction, persisted in AF patients even when the LA volume was normalized compared with controls. CONCLUSION Patients who achieved normal LA volume had better long-term outcomes of AF ablation than those who did not; however, LA abnormalities persisted even after successful ablation of AF.
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Affiliation(s)
- Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Akira Fujii
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Yasuhiro Sasaki
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Yukari Shikano
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Namiko Sakuoka
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Maki Miyazaki
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Yasunori Takasuka
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
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14
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Chen YC, Voskoboinik A, Gerche AL, Marwick TH, McMullen JR. Prevention of Pathological Atrial Remodeling and Atrial Fibrillation: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2846-2864. [PMID: 34082914 DOI: 10.1016/j.jacc.2021.04.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
Atrial enlargement in response to pathological stimuli (e.g., hypertension, mitral valve disease) and physiological stimuli (exercise, pregnancy) can be comparable in magnitude, but the diseased enlarged atria is associated with complications such as atrial fibrillation (AF), whereas physiological atrial enlargement is not. Pathological atrial enlargement and AF is also observed in a small percentage of athletes undergoing extreme/intense endurance sport and pregnant women with preeclampsia. Differences between physiological and pathological atrial enlargement and underlying mechanisms are poorly understood. This review describes human and animal studies characterizing atrial enlargement under physiological and pathological conditions and highlights key knowledge gaps and clinical challenges, including: 1) the limited ability of atria to reverse remodel; and 2) distinguishing physiological and pathological enlargement via imaging/biomarkers. Finally, this review discusses how targeting distinct molecular mechanisms underlying physiological and pathological atrial enlargement could provide new therapeutic and diagnostic strategies for preventing or reversing atrial enlargement and AF.
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Affiliation(s)
- Yi Ching Chen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Julie R McMullen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia.
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15
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Mujović NM, Marinković MM, Nedeljković I, Marković N, Banović M, Vučićević V, Stanković G, Potpara TS. Improvement of Maximal Exercise Performance After Catheter-Ablation of Atrial Fibrillation and Its Prognostic Significance for Long-Term Rhythm Outcome. J Am Heart Assoc 2021; 10:e017445. [PMID: 33506694 PMCID: PMC7955411 DOI: 10.1161/jaha.120.017445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Rhythm control may improve functional capacity in patients with atrial fibrillation (AF). Long‐term exercise tolerance improvement and its prognostic implications following catheter‐ablation (CA) of paroxysmal and nonparoxysmal AF are underreported. Methods and Results Consecutive patients underwent cardiopulmonary exercise testing just before and 12 months after their index CA of AF. Follow‐up 24‐hour Holter recordings were obtained at 6‐month intervals post‐CA, and any atrial arrhythmia >30 seconds detected after 3 months postprocedure was considered AF recurrence. Of 110 patients (mean age 57.5±10.6 years, 77.2% males) with paroxysmal AF (n=66) or nonparoxysmal AF (n=44), the 12‐month exercise tolerance improved significantly in those who maintained sinus rhythm during the first 12 months post‐CA (n=96), but not in patients with AF recurrence (n=14). After CA, the 12‐month respiratory exchange ratio at maximal workload significantly increased in patients with paroxysmal AF, whereas those with nonparoxysmal AF significantly reduced their heart rate during the 12‐month cardiopulmonary exercise testing (all P≤0.001). During the follow‐up of 42.8±7.8 months, a total of 29 patients (26.3%) experienced recurrent AF. On multivariate analysis including patients without recurrent AF at 12 months after CA, the extent of work time improvement at follow‐up cardiopulmonary exercise testing was independently associated with the rhythm outcome beyond 12 months postprocedure (hazard ratio of 0.936 [95% CI, 0.894–0.979] for each 10 seconds increase in the work time following ablation, P=0.004). Conclusions CA of AF was associated with recovery of exercise intolerance in patients with paroxysmal AF or nonparoxysmal AF. Inability to improve exercise capacity at 12 months post‐CA was an independent risk factor for later AF recurrence.
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Affiliation(s)
- Nebojša M Mujović
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | | | - Ivana Nedeljković
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Nebojša Marković
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Department of Medicine Rutgers New Jersey Medical School Newark NJ
| | - Marko Banović
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Vera Vučićević
- Center for Anesthesiology Clinical Center of Serbia Belgrade Serbia
| | - Goran Stanković
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Tatjana S Potpara
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
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16
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Kawaji T, Shizuta S, Aizawa T, Yamagami S, Kato M, Yokomatsu T, Miki S, Ono K, Kimura T. Impact of catheter ablation for atrial fibrillation on cardiac disorders in patients with coexisting heart failure. ESC Heart Fail 2020; 8:670-679. [PMID: 33305495 PMCID: PMC7835577 DOI: 10.1002/ehf2.13160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/14/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
Aims We sought to investigate the time course of cardiac disorders after catheter ablation for atrial fibrillation (AF) in patients with coexisting heart failure (HF) during long‐term follow‐up. Methods and results We analysed consecutive 280 patients undergoing first‐time catheter ablation for AF who had coexisting HF, which was defined as prior HF hospitalization, estimated right ventricular systolic pressure ≥45 mmHg, or B‐type natriuretic peptide (BNP) ≥200 pg/dL before the procedure. The primary endpoints were improvements in left ventricular ejection fraction (LVEF), E/e′, BNP, left atrial dimension (LAD), and mitral regurgitation (MR) at 1 year. The secondary endpoints were serial changes of LVEF, E/e′, BNP, LAD, and MR at 6 months, 1 year, and 5 years and cumulative incidence of HF hospitalization. During the mean follow‐up of 5.1 ± 3.0 years, 70.7% of patients were free from recurrent AF. Among patients with LVEF < 50%, E/e′ ≥ 15, BNP ≥ 200 pg/dL, LAD ≥ 40 mm, and moderate‐to‐severe MR, changes in those parameters from baseline to 1 year were 34.5 ± 9.9% to 43.2 ± 14.4% (P < 0.001), 19.7 ± 3.9 to 12.5 ± 6.6 (P < 0.001), 290 to 85 pg/dL (P < 0.001), and 100% to 37.8% (P < 0.001), respectively. The improvements in the cardiac disorders were maintained up to 5 years except for E/e′. In patients with LVEF < 40%, significant delayed improvement of LVEF beyond 1 year was observed (ΔLVEF = 10.5 ± 18.5, P = 0.001), but not in patients with LVEF of 40–49%. The cumulative incidence of HF hospitalization was 12.6% at 5 years. Baseline diastolic dysfunction was the only independent predictor for subsequent HF hospitalization. Conclusions In patients undergoing AF ablation with coexisting HF, all cardiac disorders significantly improved after the procedure, which was mostly maintained during 5 year follow‐up.
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Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Ryorei Memorial Kyoto Hospital, Kyoto, Japan.,Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | | | - Masashi Kato
- Department of Cardiology, Ryorei Memorial Kyoto Hospital, Kyoto, Japan
| | | | - Shinji Miki
- Department of Cardiology, Ryorei Memorial Kyoto Hospital, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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17
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Zeljković I, Bulj N, Kordić K, Pavlović N, Radeljić V, Benko I, Zadro Kordić I, Đula K, Kos N, Delić Brkljačić D, Manola Š. Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation. IJC HEART & VASCULATURE 2020; 31:100642. [PMID: 33015318 PMCID: PMC7522341 DOI: 10.1016/j.ijcha.2020.100642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/05/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
Data on atrial appendages' mechanics as predictors of AF recurrence after PVI is scarce. 3D and 2D-TEE have potential to provide additional data on LAA function. Patients with AFR had significantly lower LAA tissue velocity and ostium surface area. RAA tissue velocity and SVC ostium surface area were not correlated to AF recurrence.
Background Although there are numerous studies reflecting predictors of atrial fibrillation (AF) recurrence (AFR) after pulmonary vein isolation (PVI), data on atrial appendages' mechanics is scarce. This study aimed to assess atrial appendages' mechanics by 2-dimensional (2D) and 3-dimenssional (3D) transoesphageal echocardiography (TEE) and to explore its value to predict AFR after PVI. Methods Consecutive patients with paroxysmal AF undergoing first PVIwere analysed. 3D and 2D-TEE with tissue Doppler imaging (TDI) and strain analysis was obtained prior to the PVI, including: left atrial appendage (LAA) TDI and strain analysis, LAA ostium surface area, right atrial appendage’s TDI velocity and superior vena cava (SVC) ostium surface area. The primary end-point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 s. Results This single-centre, prospective study included 74 patients with paroxysmal AF (median age 59 years; 36% female; BMI 27.4 ± 4.1 kg/m2, LA volume index 32 ± 11 mL/m2). After a median follow-up of 14 (IQR 10–22) months, 21 (28%) patients had AFR. In a univariate and multivariate Cox-regression analysis LAA TDI velocity (HR 1.48, 95%CI 1.28–1.62, p < 0.001) and LAA ostium surface area(HR 1.58, 95%CI 1.06–1.81, p = 0.033) both independently predicted AFR after single PVI. RAA TDI velocity and SVC ostium surface area were not correlated to AFR. Conclusion Paroxysmal AF patients with lower LAA TDI tissue velocity and LAA ostium surface area have higher risk of developing AFR after PVI. To our knowledge, this is the first study assessing atrial appendages’ mechanics in predicting AFR after PVI. Clinical trial registration: www.drks.de(Identifier: DRKS00010495)
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Affiliation(s)
- Ivan Zeljković
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- Corresponding author at: Department of Cardiology, Sestre milosrdnice University Hospital Centre, Vinogradska cesta 29, 10 000 Zagreb, Croatia.
| | - Nikola Bulj
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Krešimir Kordić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Pavlović
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ines Zadro Kordić
- Department of Internal Medicine, County Hospital “dr. Ivo Pedišić”, Sisak, Croatia
| | - Kristijan Đula
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Kos
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Diana Delić Brkljačić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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18
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Blum S, Aeschbacher S, Meyre P, Zwimpfer L, Reichlin T, Beer JH, Ammann P, Auricchio A, Kobza R, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Henz S, Meyer‐Zürn C, Roten L, Schwenkglenks M, Sticherling C, Kühne M, Osswald S, Conen D. Incidence and Predictors of Atrial Fibrillation Progression. J Am Heart Assoc 2019; 8:e012554. [PMID: 31590581 PMCID: PMC6818023 DOI: 10.1161/jaha.119.012554] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
Background The incidence and predictors of atrial fibrillation (AF) progression are currently not well defined, and clinical AF progression partly overlaps with rhythm control interventions (RCIs). Methods and Results We assessed AF type and intercurrent RCIs during yearly follow-ups in 2869 prospectively followed patients with paroxysmal or persistent AF. Clinical AF progression was defined as progression from paroxysmal to nonparoxysmal or from persistent to permanent AF. An RCI was defined as pulmonary vein isolation, electrical cardioversion, or new treatment with amiodarone. During a median follow-up of 3 years, the incidence of clinical AF progression was 5.2 per 100 patient-years, and 10.9 per 100 patient-years for any RCI. Significant predictors for AF progression were body mass index (hazard ratio [HR], 1.03; 95% CI, 1.01-1.05), heart rate (HR per 5 beats/min increase, 1.05; 95% CI, 1.02-1.08), age (HR per 5-year increase 1.19; 95% CI, 1.13-1.27), systolic blood pressure (HR per 5 mm Hg increase, 1.03; 95% CI, 1.00-1.05), history of hyperthyroidism (HR, 1.71; 95% CI, 1.16-2.52), stroke (HR, 1.50; 95% CI, 1.19-1.88), and heart failure (HR, 1.69; 95% CI, 1.34-2.13). Regular physical activity (HR, 0.80; 95% CI, 0.66-0.98) and previous pulmonary vein isolation (HR, 0.69; 95% CI, 0.53-0.90) showed an inverse association. Significant predictive factors for RCIs were physical activity (HR, 1.42; 95% CI, 1.20-1.68), AF-related symptoms (HR, 1.84; 95% CI, 1.47-2.30), age (HR per 5-year increase, 0.88; 95% CI, 0.85-0.92), and paroxysmal AF (HR, 0.61; 95% CI, 0.51-0.73). Conclusions Cardiovascular risk factors and comorbidities were key predictors of clinical AF progression. A healthy lifestyle may therefore reduce the risk of AF progression.
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Affiliation(s)
- Steffen Blum
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Division of Internal MedicineDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Stefanie Aeschbacher
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Pascal Meyre
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Leon Zwimpfer
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Division of CardiologyDepartment of MedicineInselspitalBern University HospitalUniversity of BernSwitzerland
| | - Jürg H. Beer
- Department of MedicineCantonal Hospital of Baden and Molecular CardiologyUniversity Hospital of ZurichZurichSwitzerland
| | - Peter Ammann
- Division of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Angelo Auricchio
- Division of CardiologyFondazione Cardiocentro TicinoLuganoSwitzerland
| | - Richard Kobza
- Division of CardiologyLuzerner KantonsspitalLuzernSwitzerland
| | - Paul Erne
- Laboratory for Signal TransductionDepartment of BiomedicineUniversity of BaselBaselSwitzerland
| | | | | | - Dipen Shah
- Division of CardiologyUniversity Hospital GenevaGenevaSwitzerland
| | - Jürg Schläpfer
- Service of CardiologyUniversity Hospital LausanneLausanneSwitzerland
| | - Selina Henz
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Christine Meyer‐Zürn
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Laurent Roten
- Division of CardiologyDepartment of MedicineInselspitalBern University HospitalUniversity of BernSwitzerland
| | | | - Christian Sticherling
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Michael Kühne
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Stefan Osswald
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - David Conen
- Division of CardiologyDepartment of MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Population Health Research InstituteMcMaster UniversityHamiltonOntarioCanada
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19
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Akkaya E, Berkowitsch A, Rieth A, Erkapic D, Hamm CW, Neumann T, Kuniss M. Clinical outcome and left atrial function after left atrial roof ablation using the cryoballoon technique in patients with symptomatic persistent atrial fibrillation. Int J Cardiol 2019; 292:112-118. [DOI: 10.1016/j.ijcard.2019.04.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
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Li YG, Gong CQ, Zhao MZ, Sun J, Wang QS, Zhang PP, Feng XF, Yu Y, Yu YC, Liang BE. Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure. J Cardiovasc Electrophysiol 2019; 30:1868-1876. [PMID: 31353748 DOI: 10.1111/jce.14094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Catheter ablation of atrial fibrillation (AFCA) and left atrial appendage closure (LAAC) exert opposite effects on left atrial (LA) size. We aim to observe the net impact of combined AFCA and LAAC strategy on LA size and explore those factors which might affect the postprocedure LA structural remodeling. METHODS A total of 53 patients, who underwent combined AFCA and Watchman LAAC in our center from March to December 2017, were enrolled. Atrial fibrillation (AF) recurrence was monitored after the procedure. Left atrial volume (LAV) and left atrial appendage volume (LAAV) were measured by Mimics based on dual-source computed tomography images. RESULTS At 6 months, sinus rhythm (SR) was maintained in 79.2% patients. LAV was significantly reduced (130.2 ± 36.3 mL to 107.1 ± 30.0 ml; P < .001) in SR maintenance group, but not in AF recurrence group (138.8 ± 39.3 mL to 137.9 ± 36.9 mL; P = .671). In SR group, preoperative LAAV/LAV ratio (B = -0.894; P = .015), NT-proBNP (B = 0.005; P = .019) and left ventricular ejection fraction (LVEF) (B = -0.778; P < .001) could interactively affect the extent of postoperative LA structural reverse remodeling, among which LAAV/LAV ratio could independently predict the significance of reverse remodeling (≥15% reduction in LAV) (OR, 0.56; 95% CI, 0.34-0.90; P = .018). A preoperative LAAV/LAV ratio less than 7.1% is indicative of significant LA structural reverse remodeling in this patient cohort. CONCLUSIONS LA structural reverse remodeling could be evidenced in patients with maintained SR following combined AFCA and LAAC. Smaller LAAV/LAV ratio, higher NT-proBNP or lower LVEF at baseline are associated with more significant LA structural reverse remodeling, while LAAV/LAV ratio can predict the significance of the process after one-stop treatment.
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Affiliation(s)
- Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Qi Gong
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Zhe Zhao
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun-Shan Wang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng-Pai Zhang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Fei Feng
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Yu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Chi Yu
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing-Er Liang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Soga F, Tanaka H, Mochizuki Y, Mukai J, Suto M, Takada H, Hatani Y, Matsuzoe H, Hatazawa K, Sano H, Ooka J, Shimoura H, Matsumoto K, Fukuzawa K, Hirata KI. Combined assessment of left atrial volume parameters for predicting recurrence of atrial fibrillation following pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Echocardiography 2019; 36:862-869. [PMID: 30908731 DOI: 10.1111/echo.14315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/24/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Our aim was to test the hypothesis that comprehensive simplified left atrial (LA) assessment derived from routine echocardiography may be more useful than assessment of LA volume alone for predicting atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). METHODS We studied 156 patients with paroxysmal AF (PAF) who had undergone PVI. Echocardiography was performed within two days before PVI. Maximum (Max-LAVi) and minimum LA volume index (Min-LAVi) were calculated with the biplane modified Simpson's method, and then normalized to the body surface area. On the basis of previous findings, the predefined cutoff value of Max-LAVi for AF recurrence was set at Max-LAVi ≥ 34 mL/m2 . ΔLA volume index (ΔLAVi) was also calculated as Max-LAVi minus Min-LAVi. The follow-up period after PVI was 24 months. RESULTS AF recurrence was observed in 35 patients. Multivariate logistic regression analysis showed that ΔLAVi (odds ratio [OR]: 1.131; 95% confidence interval [CI]: 1.057-1.221; P < 0.001) was an independent predictor of AF recurrence. Sequential logistic regression models for predicting AF recurrence revealed that a model based on clinical variables including age, gender and AF duration (χ2 = 1.65) was improved by the addition of Max-LAVi ≥ 34 mL/m2 (χ2 = 13.8; P < 0.001), and further improved by the addition of ΔLAVi (χ2 = 18.2; P = 0.036). Of note is that only 1.02 ± 0.10 minutes per patient was needed to obtain a comprehensive LA assessment that included Max-LAVi, Min-LAVi, and ΔLAVi. CONCLUSION This easy-to-use comprehensive simplified LA approach from routine echocardiography may well have clinical implications for better management of PAF patients.
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Affiliation(s)
- Fumitaka Soga
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuhide Mochizuki
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Mukai
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makiko Suto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Takada
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Hatani
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Matsuzoe
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiko Hatazawa
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Sano
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junichi Ooka
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Shimoura
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Echocardiographic assessment in patients with atrial fibrillation (AF) and normal systolic left ventricular function before and after catheter ablation: If AF begets AF, does pulmonary vein isolation terminate the vicious circle? Cardiol J 2019; 27:126-135. [PMID: 30701515 DOI: 10.5603/cj.a2019.0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) can be curative. There are conflicting data on whether AF associated atrial and ventricular structural remodeling reverses after ablation. The aim of this study was to evaluate the hemodynamic effect of AF ablation in patients with preserved left ventricular ejection fraction (LVEF). METHODS Forty three AF patients were studied (aged 56 ± 11 years; 29 male, 23% persistent AF, LVEF ≥ 50%) in whom RFCA was performed. Echocardiographic evaluation of atrial and ventricular diameters, volumes and strain imaging by two-dimensional speckle tracking were performed before and at least 6 months after RFCA. Nine patients had AF during baseline examination. RESULTS A significant decrease in the left (LA) and right (RA) atrial volume and an increase in the LA strain were observed 15 ± 7 months after RFCA. In the subgroup with baseline sinus rhythm, the increment in LA strain was only borderline significant. An increase in RA, right ventricular (RV) and Biatrial strain was noticed (p < 0.05). LVEF and global longitudinal strain of the left ventricle (LV), however, did not improve substantially. CONCLUSIONS Radiofrequency catheter ablation of AF in patients with preserved LV systolic function results in significant improvement in RA and RV function with a substantial reduction in LA and RA size. No deleterious impact of AF ablation on LA function was revealed.
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Celik AI, Kanadasi M, Demir M, Deniz A, Akilli RE, Deveci OS, Cagliyan CE, Ozmen C, Ikikardes F, Karaaslan MB. Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio. Indian Pacing Electrophysiol J 2018; 19:9-14. [PMID: 30712532 PMCID: PMC6354203 DOI: 10.1016/j.ipej.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/02/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. Methods 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). Results In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ± 18.13 ml and 53.24 ± 22.11 ml vs 48.85 ± 12.89 ml and 42.08 ± 13.85 (p = 0.037). LAVi were 20.9 ± 8.91 ml/m2 and 26.85 ± 11.28 ml/m2 vs 25.36 ± 6.21 and 21.87 ± 6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ± 4.09 ng/ml and 6.02 ± 2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ± 1.07 103/μl and 1.98 ± 0.66 103/μl (p = 0.674). Conclusion LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.
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Affiliation(s)
- Aziz Inan Celik
- Bayburt State Hospital, Department of Cardiology, Bayburt, Turkey.
| | - Mehmet Kanadasi
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Mesut Demir
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Ali Deniz
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Rabia Eker Akilli
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Onur Sinan Deveci
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Caglar Emre Cagliyan
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Caglar Ozmen
- Pazarcık State Hospital, Department of Cardiology, Kahramanmaras, Turkey.
| | - Firat Ikikardes
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
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A three-year longitudinal study of the relation between left atrial diameter remodeling and atrial fibrillation ablation outcome. J Geriatr Cardiol 2018; 15:486-491. [PMID: 30364811 PMCID: PMC6198265 DOI: 10.11909/j.issn.1671-5411.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The long-term prognostic influence of left atrial diameter (LAD) remodeling on the status of post-radiofrequency catheter ablation (RFCA) atrial fibrillation (AF) is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. METHODS Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual (predicted) 3-year LAD using a longitudinal linear mixed model (1st stage). Logistic regression models based on the baseline LAD (Model 1), actual (predicted) 3-year LAD (Model 2) (2nd stage), and observed 3-year LAD (Model 3) were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve (AUC) were used to assess the performance of models. RESULTS The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. CONCLUSIONS This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.
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Kim YG, Shim J, Oh SK, Park HS, Lee KN, Hwang SH, Choi JI, Kim YH. Different Responses of Left Atrium and Left Atrial Appendage to Radiofrequency Catheter Ablation of Atrial Fibrillation: a Follow Up MRI study. Sci Rep 2018; 8:7871. [PMID: 29777140 PMCID: PMC5959897 DOI: 10.1038/s41598-018-26212-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/08/2018] [Indexed: 01/08/2023] Open
Abstract
Atrial fibrillation (AF) is known to cause adverse remodeling of left atrium (LA). Radiofrequency catheter ablation (RFCA) of AF is associated with decrease in LA volume. However, the impact of RFCA on left atrial appendage (LAA) volume and hemodynamic function is not fully understood. We analyzed 123 patients who underwent cardiac magnetic resonance imaging (MRI) evaluation before and after RFCA in Korea University Anam Hospital. LA and LAA volume were measured before and after RFCA based on cardiac MRI. Baseline LA volume was 99.5 ± 38.4 cm3 and decreased to 74.6 ± 28.5 cm3 after RFCA (p < 0.001). LA diameter measured with transthoracic echocardiography was also decreased after RFCA (43.3 ± 6.2 mm at baseline and 39.9 ± 5.9 mm at follow up; p < 0.001). However, LAA volume was significantly increased after RFCA (19.4 ± 8.5 cm3 at baseline and 23.7 ± 13.3 cm3 at follow up; p < 0.001). Total ablation time and additional substrate modification was associated with change in LA volume. After RFCA, average LAA velocity measured by transesophageal echocardiography was increased to 51.0 cm/sec from 41.1 cm/sec (p < 0.001). In conclusion, LAA volume was increased after RFCA in contrast to LA volume. Our data raise a concern about worsening hemodynamics of LA and LAA following RFCA and long term clinical significance of enlarged LAA after RFCA needs further evaluation.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea.
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea
| | - Hee-Soon Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Republic of Korea
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Papadopoulos CH, Oikonomidis D, Lazaris E, Nihoyannopoulos P. Echocardiography and cardiac arrhythmias. Hellenic J Cardiol 2017; 59:140-149. [PMID: 29203161 DOI: 10.1016/j.hjc.2017.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/21/2017] [Accepted: 11/25/2017] [Indexed: 01/07/2023] Open
Abstract
Cardiac arrhythmias refer to any abnormality or disturbance in the normal activation sequence of the myocardium and may be indicative of structural heart disease and the cause of significant cardiovascular complications and sudden cardiac death. The following review summarizes the current state-of-the-art knowledge on the role of echocardiography in the management of cardiac arrhythmias and focuses on atrial fibrillation and ventricular arrhythmias where echocardiography presents a particular diagnostic and prognostic interest. Moreover, a brief reference is made to the effect of cardiac arrhythmias and conduction abnormalities on echocardiographic examination.
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Affiliation(s)
| | | | - Efstathios Lazaris
- 2nd Cardiology Department, Korgialenio-Benakio Red Cross Hospital, Athens, Greece
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Holmes JW, Laksman Z, Gepstein L. Making better scar: Emerging approaches for modifying mechanical and electrical properties following infarction and ablation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2015; 120:134-48. [PMID: 26615948 DOI: 10.1016/j.pbiomolbio.2015.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/13/2015] [Accepted: 11/20/2015] [Indexed: 12/31/2022]
Abstract
Following myocardial infarction (MI), damaged myocytes are replaced by collagenous scar tissue, which serves an important mechanical function - maintaining integrity of the heart wall against enormous mechanical forces - but also disrupts electrical function as structural and electrical remodeling in the infarct and borderzone predispose to re-entry and ventricular tachycardia. Novel emerging regenerative approaches aim to replace this scar tissue with viable myocytes. Yet an alternative strategy of therapeutically modifying selected scar properties may also prove important, and in some cases may offer similar benefits with lower risk or regulatory complexity. Here, we review potential goals for such modifications as well as recent proof-of-concept studies employing specific modifications, including gene therapy to locally increase conduction velocity or prolong the refractory period in and around the infarct scar, and modification of scar anisotropy to improve regional mechanics and pump function. Another advantage of scar modification techniques is that they have applications well beyond MI. In particular, ablation treats electrical abnormalities of the heart by intentionally generating scar to block aberrant conduction pathways. Yet in diseases such as atrial fibrillation (AF) where ablation can be extensive, treating the electrical disorder can significantly impair mechanical function. Creating smaller, denser scars that more effectively block conduction, and choosing the location of those lesions by balancing their electrical and mechanical impacts, could significantly improve outcomes for AF patients. We review some recent advances in this area, including the use of computational models to predict the mechanical effects of specific lesion sets and gene therapy for functional ablation. Overall, emerging techniques for modifying scar properties represents a potentially important set of tools for improving patient outcomes across a range of heart diseases, whether used in place of or as an adjunct to regenerative approaches.
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Affiliation(s)
- Jeffrey W Holmes
- Departments of Biomedical Engineering and Medicine, Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States.
| | - Zachary Laksman
- Cardiac Electrophysiology, University of British Columbia, Vancouver, BC, Canada
| | - Lior Gepstein
- Departments of Cardiology (Ramban Health Care Campus) and Physiology, The Rappaport Faculty of Medicine and Research Institute, Technion - Israel Institute of Technology, Haifa, Israel
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