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Rettmann ME, Holmes DR, Monahan KH, Breen JF, Bahnson TD, Mark DB, Poole JE, Ellis AM, Silverstein AP, Al-Khalidi HR, Lee KL, Robb RA, Packer DL. Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy. Circ Arrhythm Electrophysiol 2021; 14:e008540. [PMID: 33848199 DOI: 10.1161/circep.120.008540] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Maryam E Rettmann
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - David R Holmes
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Kristi H Monahan
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Jerome F Breen
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Tristram D Bahnson
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle, WA (J.E.P.)
| | - Alicia M Ellis
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Adam P Silverstein
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Kerry L Lee
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Richard A Robb
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Douglas L Packer
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
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Khidr S, Doyle M, Rayarao G, Belden W, Biederman RWW. A Model Incorporating Left Ventricular Impedance Index may be Explanatory for Late Pulmonary Vein Isolation Failure. AUSTIN JOURNAL OF CLINICAL CARDIOLOGY 2020; 6:1069. [PMID: 35419574 PMCID: PMC9005070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To study the influence of a flow-based Impedance Index to attempt to explain the persistent late failure rate of Pulmonary Vein Isolation (PVI) in patients with Atrial Fibrillation (AF). BACKGROUND We recently described a flow-based Impedance Index for left ventricular ejection into the aorta and noted an association with Major Adverse Cardiovascular Event Rate (MACE). While the Impedance Index is not routinely measured in PVI patients it approximates to measures derivable from the left ventricular ejection fraction (EF). We sought to assess the Impedance Index's influence on PVI failure rate in combination with indices of left atrial size. METHODS In AF patients (n=100) undergoing a Cardiovascular Magnetic Resonance (CMR) imaging examination prior to undergoing PVI we assessed baseline characteristics for their influence on the PVI failure rate at 3-12 months. Uni-variable and multi-variable binary logistic models were performed to find predictors of the PVI failure rate at follow-up. RESULTS All patients underwent PVI and CMR imaging. A total of 26 (26%) patients had late AF recurrence at 3-12 months follow-up. Multi-variable models that predicted PVI failure were: 1) the baseline Impedance Index and LA volume index (p<0.05) and 2) the baseline Impedance Index and the degree of mitral valve regurgitation (MR) (p<0.001). While the Impedance Index was derived from EF, EF per se was not a predictor of PVI failure (p=0.28). CONCLUSIONS We have provided evidence of the influence of a flow-based Impedance Index on the PVI late failure rate which is significant and remains explanatory when adjusting for measures of atrial size, MR grade and LA volume index. Direct measure of the Impedance Index was not available here and was derived from EF measures. Further work is needed to directly measure the Impedance Index in a PVI population and determine the mechanism for the influence on PVI failure, which may lead to modification of the ablation procedure to improve the success rate.
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Affiliation(s)
| | - Mark Doyle
- Allegheny General Hospital, Pittsburgh, PA, USA
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Miyama H, Takatsuki S, Hashimoto K, Yamashita T, Fujisawa T, Katsumata Y, Kimura T, Fukuda K. Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1289-1294. [PMID: 33058199 DOI: 10.1111/pace.14092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/25/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The anatomical changes in pulmonary veins (PVs) after cryoballoon ablation (CBA) are unclear. We aimed to determine the morphological changes in the PVs and left atrium (LA) along with the predictive factors for clinical PV stenosis. METHODS We analyzed data of 320 PVs from 80 patients who underwent CBA for atrial fibrillation (age: 62 ± 10 years, 59 males). All patients underwent pre- and post-procedural cardiac computed tomography. We defined clinical PV stenosis when the cross-sectional area decreased by more than 50%. RESULTS The average ostial PV area and LA volume decreased significantly after CBA (pre- vs post-CBA; 2.4 ± 1.0 cm2 vs 2.3±1.1 cm2 , P < .001, 75.0 ± 23.2 cm3 vs 70.7 ± 21.9 cm3 , P < .001, respectively). There was a significant correlation between the reduction rates of the PV area and those of LA volume (R = 0.411, P < .001). The larger preoperative PV area and greater reduction in LA volume were associated with advanced PV narrowing. Clinical PV stenosis was observed in six PVs, was more common in females (male vs female; 0.8% vs 4.8%, P = .043), and tended to be more frequent in left PVs (left PVs vs right PVs; 3.1% vs 0.6%: P = .107), irrespective of the LA volume reduction. CONCLUSIONS The significant reduction of the ostial PV area occurred after CBA, which correlated with the reduction rate of LA volume. The narrowing of the PV was partly produced by the LA volume reduction. Clinical PV stenosis was more common in females and tended to be more frequent in left PVs.
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Affiliation(s)
- Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Terumasa Yamashita
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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