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Payami B, Akiash N, Kiarsi M, Moradi A, Kheradmandpour M, Abbaspour S. Evaluation of the Effect of Conversion of Nonvalvular Atrial Fibrillation to Sinus Rhythm on Cardiac Remodeling. Cureus 2024; 16:e60504. [PMID: 38883085 PMCID: PMC11180483 DOI: 10.7759/cureus.60504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) represents the most prevalent cardiac arrhythmia globally, with a significant burden on mortality and morbidity. While rhythm control strategies, particularly electrical cardioversion (EC), have gained traction in recent years, the precise impact of sinus rhythm (SR) restoration on cardiac reverse remodeling remains a subject of debate. METHODS In this study, 23 AF patients underwent elective EC. AF diagnosis was made via ECG by a cardiologist, and candidates for cardioversion were selected by an electrophysiologist. Transthoracic echocardiography (TTE) by utilizing two-dimensional, three-dimensional, and tissue Doppler imaging modalities was performed before cardioversion. Patients who maintained SR after six months underwent a second TTE evaluation. RESULTS SR was restored successfully in all 23 patients and 15 patients (65.2%) maintained SR after six months. SR group had significantly lower baseline cardiac output (CO) and indexed left ventricular end-systolic volume (LVESVi), and better European Heart Rhythm Association (EHRA) scores after six months. Within the SR group, patients exhibited significant changes in mitral regurgitation, tricuspid regurgitation, EHRA score, LVESVi, stroke volume, left ventricle ejection fraction, left ventricle global longitudinal strain, indexed minimum left atrial volume, left atrial emptying fraction, and left and right atrial diameters. Reduced CO was associated with AF recurrence. Receiver operating curve analysis revealed that CO value can predict six-month AF recurrence with a cut-off point of 2.3. CONCLUSION Our study underscores the beneficial effects of SR restoration on cardiac parameters in AF patients post EC. Notably, CO value emerged as a predictor of AF recurrence, emphasizing the importance of comprehensive assessments for predicting long-term outcomes.
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Affiliation(s)
- Babak Payami
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Nehzat Akiash
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Mohammadreza Kiarsi
- Department of Cardiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Amir Moradi
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Mohammad Kheradmandpour
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Somayeh Abbaspour
- Department of Cardiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
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Águila‐Gordo D, Jiménez‐Díaz J, Negreira‐Caamaño M, Martínez‐Del Rio J, Ruiz‐Pastor C, Sánchez Pérez I, Piqueras‐Flores J. Usefulness of risk scores and predictors of atrial fibrillation recurrence after elective electrical cardioversion. Ann Noninvasive Electrocardiol 2024; 29:e13095. [PMID: 37986620 PMCID: PMC10770812 DOI: 10.1111/anec.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Electrical cardioversion (ECV) is a frequently used procedure for restoring sinus rhythm in atrial fibrillation (AF); however, the rate of recurrence is high. The identification of patients at high risk of recurrence could influence the decision-making process. The present study evaluates the predictive value of risk scores in atrial fibrillation recurrence after elective electrical cardioversion. METHODS Unicentric, observational, and prospective study of adult patients who have undergone an elective ECV as rhythm control strategy between July 2017 and September 2022. RESULTS From the 283 analyzed patients (mean age 63.95 ± 10.76212, 74.9% male); 99 had paroxysmal AF (35%) and 159 (59%) presented AF recurrence during a follow-up of 6 months. In patients with post-ECV AF recurrence, the period of time from diagnosis until the performance of the procedure was longer (393 ± 891 vs. 195 ± 527, p = .02). No paroxysmal AF (71.3% vs. 57.8%, p = .02) and LA dilatation with >40 mL/m2 (35.9% vs. 23.3%, p = .02) volumes were more frequent within these patients. AF recurrence was more frequent in patients who had previous ECV (HR = 1.32; 95% CI: 1.12-2.35; p = .01) and more than 1 shock to recover sinus rhythm (HR = 1.62; 95% CI: 1.07-1.63; p = .01). The SLAC, ALARMEc, ATLAS, and CAAP-AF scores were statistically significant, although with a moderate predictive capacity for post-ECV recurrence. CONCLUSIONS Risk scores analyzed showed a modest value predicting AF recurrence after ECV. Previous ECV, and greater difficulty in restoring SR were independent predictors of recurrence.
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Affiliation(s)
- Daniel Águila‐Gordo
- Cardiology DepartmentHospital General Universitario de Ciudad RealCiudad RealSpain
| | - Javier Jiménez‐Díaz
- Arrhythmia Unit, Cardiology DepartmentHospital General Universitario de Ciudad RealCiudad RealSpain
| | | | | | | | - Ignacio Sánchez Pérez
- Hemodynamics and Interventional Cardiology Unit, Cardiology DepartmentHospital General Universitario de Ciudad RealCiudad RealSpain
| | - Jesús Piqueras‐Flores
- Medicine FacultyCastilla La‐Mancha UniversityCiudad RealSpain
- Cardiomyopathies and Inherited Disease Unit, Cardiology DepartmentHospital General Universitario de Ciudad RealCiudad RealSpain
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Sun S, Wang L, Lin J, Sun Y, Ma C. An effective prediction model based on XGBoost for the 12-month recurrence of AF patients after RFA. BMC Cardiovasc Disord 2023; 23:561. [PMID: 37974062 PMCID: PMC10655386 DOI: 10.1186/s12872-023-03599-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common heart rhythm disorder that can lead to complications such as stroke and heart failure. Radiofrequency ablation (RFA) is a procedure used to treat AF, but it is not always successful in maintaining a normal heart rhythm. This study aimed to construct a clinical prediction model based on extreme gradient boosting (XGBoost) for AF recurrence 12 months after ablation. METHODS The 27-dimensional data of 359 patients with AF undergoing RFA in the First Affiliated Hospital of Soochow University from October 2018 to November 2021 were retrospectively analysed. We adopted the logistic regression, support vector machine (SVM), random forest (RF) and XGBoost methods to conduct the experiment. To evaluate the performance of the prediction, we used the area under the receiver operating characteristic curve (AUC), the area under the precision-recall curve (AP), and calibration curves of both the training and testing sets. Finally, Shapley additive explanations (SHAP) were utilized to explain the significance of the variables. RESULTS Of the 27-dimensional variables, ejection fraction (EF) of the left atrial appendage (LAA), N-terminal probrain natriuretic peptide (NT-proBNP), global peak longitudinal strain of the LAA (LAAGPLS), left atrial diameter (LAD), diabetes mellitus (DM) history, and female sex had a significant role in the predictive model. The experimental results demonstrated that XGBoost exhibited the best performance among these methods, and the accuracy, specificity, sensitivity, precision and F1 score (a measure of test accuracy) of XGBoost were 86.1%, 89.7%, 71.4%, 62.5% and 0.67, respectively. In addition, SHAP analysis also proved that the 6 parameters were decisive for the effect of the XGBoost-based prediction model. CONCLUSIONS We proposed an effective model based on XGBoost that can be used to predict the recurrence of AF patients after RFA. This prediction result can guide treatment decisions and help to optimize the management of AF.
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Affiliation(s)
- ShiKun Sun
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Li Wang
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Jia Lin
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - YouFen Sun
- The Shengcheng Street Health Center, Shouguang, 262700, China.
| | - ChangSheng Ma
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Brandt RR, Stöbe S, Ewers A, Helfen A. [Echocardiography in cardiac arrhythmias]. Herzschrittmacherther Elektrophysiol 2023; 34:256-264. [PMID: 37584761 DOI: 10.1007/s00399-023-00956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
Echocardiography plays a key role in planning and guidance of electrophysiological procedures. After exclusion of structural heart disease, echocardiography provides insight into the extent of left atrial remodeling by determining left atrial metrics. This "biomarker" is associated with the risk of new-onset atrial fibrillation and predictive of atrial fibrillation recurrence after ablation. Transesophageal echocardiography is necessary to exclude left atrial thrombi and is able to guide a transseptal puncture. In case of a rare but life-threatening cardiac tamponade, an echocardiographic-guided pericardiocentesis ensures quick and effective treatment. Left ventricular ejection fraction and deformation analysis determined by echocardiography are established methods for risk stratification in patients with systolic dysfunction and used to guide pharmacological and device therapy.
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Affiliation(s)
- Roland R Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Aydan Ewers
- Medizinische Universitätsklinik II - Kardiologie und Angiologie, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland
| | - Andreas Helfen
- Abteilung für Kardiologie, Katholische St. Paulus Gesellschaft, St.-Marien-Hospital Lünen, Altstadtstr. 23, 44534, Lünen, Deutschland
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He P, Pan Y, Jiang J, Fan F, Zhou J, Xia Y, Liu J, Yang N, Hao Y, Li J, Liu J, Zhao D, Huo Y. In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015-2019. BMJ Open 2023; 13:e070070. [PMID: 37277219 DOI: 10.1136/bmjopen-2022-070070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVES The optimal treatment strategy remains debatable in patients with atrial fibrillation (AF) and heart failure. Our objectives were to summarise in-hospital therapies and determine factors associated with treatment strategy selections. DESIGN A retrospective study analysing the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project from 2015 to 2019. SETTING The CCC-AF project included patients from 151 tertiary and 85 secondary hospitals across 30 provinces in China. PARTICIPANTS Patients with AF and left ventricular systolic dysfunction (LVSD, defined as left ventricular ejection fraction<50%) were included, with 5560 patients in the study sample. METHODS Patients were classified by treatment strategies. In-hospital treatments and trends of therapies were analysed. Multiple logistic regression models were used to find determinants of treatment strategies. RESULTS Rhythm control therapies were used in 16.9% of patients with no significant trends (p trend=0.175). Catheter ablation was used in 5.5% of patients, increasing from 3.3% in 2015 to 6.6% in 2019 (p trend<0.001). Factors negatively associated with rhythm control included increased age (OR 0.973, 95% CI 0.967 to 0.980), valvular AF (OR 0.618, 95% CI 0.419 to 0.911), AF types (persistent: OR 0.546, 95% CI 0.462 to 0.645; long-standing persistent: OR 0.298, 95% CI 0.240 to 0.368), larger left atrial diameters (OR 0.966, 95% CI 0.957 to 0.976) and higher Charlson Comorbidity Index scores (CCI 1-2: OR 0.630, 95% CI 0.529 to 0.750; CCI≥3: OR 0.551, 95% CI 0.390 to 0.778). Higher platelet counts (OR 1.025, 95% CI 1.013 to 1.037) and prior rhythm control attempts (electrical cardioversion: OR 4.483, 95% CI 2.369 to 8.483; catheter ablation: OR 4.957, 95% CI 3.072 to 7.997) were positively associated with rhythm control strategies. CONCLUSION In China, non-rhythm control strategy remained the dominant choice in patients with AF and LVSD. Age, AF types, prior treatments, left atrial diameters, platelet counts and comorbidities were major determinants of treatment strategies. Guideline-adherent therapies should be further promoted. STUDY REGISTRATION NUMBER NCT02309398.
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Affiliation(s)
- Pengkang He
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yannan Pan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jing Zhou
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yulong Xia
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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Jin S, Lin W, Fang X, Liao H, Zhan X, Fu L, Jiang J, Ye X, Liu H, Chen Y, Pu S, Wu S, Deng H, Xue Y. High-Power, Short-Duration Ablation under the Guidance of Relatively Low Ablation Index Values for Paroxysmal Atrial Fibrillation: Long-Term Outcomes and Characteristics of Recurrent Atrial Arrhythmias. J Clin Med 2023; 12:jcm12030971. [PMID: 36769620 PMCID: PMC9917927 DOI: 10.3390/jcm12030971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the difference in effectiveness and safety of high-power, short-duration (HPSD) radiofrequency catheter ablation (RFA) guided by relatively low ablation index (AI) values and conventional RFA in paroxysmal atrial fibrillation (PAF) patients. METHODS The HPSD RFA strategy (40-50 W, AI 350-400 for anterior, 320-350 for posterior wall; n = 547) was compared with the conventional RFA strategy (25-40 W, without AI; n = 396) in PAF patients who underwent their first ablation. Propensity-score matching analyses were used to compare the outcomes of the two groups while controlling for confounders. RESULTS After using propensity-score matching analysis, the HPSD group showed a higher early recurrence rate (22.727% vs. 13.636%, p = 0.003), similar late recurrence rate, and comparable safety (p = 0.604) compared with the conventional group. For late recurrent atrial arrhythmia types, the rate of regular atrial tachycardia was significantly higher in the HPSD group (p = 0.013). Additionally, the rate of chronic pulmonary vein reconnection and non-pulmonary vein triggers during repeat procedures was similar in both groups. CONCLUSIONS For PAF patients, compared with the conventional RFA strategy, the HPSD RFA strategy at relatively low AI settings had a higher early recurrence rate, similar long-term success rate, and comparable safety.
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Affiliation(s)
- Shuyu Jin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Weidong Lin
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xianhong Fang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Hongtao Liao
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xianzhang Zhan
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Lu Fu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Junrong Jiang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xingdong Ye
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Huiyi Liu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Yanlin Chen
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Sijia Pu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Shulin Wu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Hai Deng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Correspondence: (H.D.); (Y.X.)
| | - Yumei Xue
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Correspondence: (H.D.); (Y.X.)
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Atrial cardiomyopathy: Diagnosis, clinical implications and unresolved issues in anticoagulation therapy. J Electrocardiol 2023; 76:1-10. [PMID: 36370545 DOI: 10.1016/j.jelectrocard.2022.10.012] [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: 04/19/2022] [Revised: 10/15/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Atrial cardiomyopathy (AC) is an evolving pathophysiological entity that has expanded our understanding regarding the atrium and its role in arrhythmogenesis and cardiac thromboembolism. The pathological myocardium in AC promotes arrhythmogenesis through mechanical dysfunction (hypocontractility, fibrosis), adverse alterations of the endothelium and secretion of prothrombotic factors (IL-6, IL-8, TNF-a). 'Red flags', indicative of AC, can be recognized either non-invasively by electrocardiography, echocardiography and cardiac magnetic resonance imaging or invasively by high-density electroanatomical mapping as low bipolar voltage areas of the affected myocardium. Signs of AC have been strongly associated with an increased risk of ischemic stroke, even embolic strokes of undetermined source, regardless of the coexistence of atrial fibrillation (AF). The underlying existence of AC has been negatively correlated with the success rate of catheter ablation of AF. The clinical value of AC is the provision of a novel pathway regarding the potential mechanisms of cerebrovascular events of cardiac thromboembolic origin. In addition, AC may serve as a risk stratification tool to predict the long-term responders of AF catheter ablation.
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A Prognostic Score To Predict Atrial fibrillation Recurrence After External Electrical Cardioversion-SLAC Score. Crit Pathw Cardiol 2022; 21:194-200. [PMID: 36413399 DOI: 10.1097/hpc.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) recurrence after a successful external electrical cardioversion (ECV) is common. Assessing an individual's risk of AF recurrence is a critical part of the treatment plan. We aimed to develop a prognostic prediction score to predict AF recurrence in AF patients who underwent successful ECV. METHODS A retrospective cohort study that included AF patients who underwent successful ECV was conducted with a primary outcome of AF recurrence at 6 months. Logistic regression analysis was done to identify variables, and a prognostic prediction score was created and internally validated. RESULTS Four prognostic predictors were identified, including the type of AF, persistent AF (1 point) and long-standing persistent AF (4 points), previous cardioversion (1 point), stroke/transient ischemic attack (3 points), and left atrial volume index ≥40 mL/m 2 (6 points). The total score of 14 was further divided into 3 risk groups; low-risk (0-2 points), moderate-risk (3-7 points), and high-risk (8-14 points). The positive likelihood ratio for a moderate-risk patient was 2.08 (95% CI, 1.64-2.63) and for a high-risk patient was 7.90 (95% CI, 2.48-25.17). The score showed good discrimination power with the c-statistic of 0.74 (95% CI, 0.69-0.79). CONCLUSIONS A simple prognostic prediction score for AF recurrence after successful ECV was created with a promising internally validated discrimination power. An external assessment of its usefulness as a tool to identify patients with low, moderate, and high risk for AF recurrence is warranted.
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Li Y, Li Y, Sun L, Ye X, Cai Q, Zhu W, Guo D, Ding X, Wang J, Lv X. Left atrial strain for predicting recurrence in patients with non-valvular atrial fibrillation after catheter ablation: a single-center two-dimensional speckle tracking retrospective study. BMC Cardiovasc Disord 2022; 22:468. [PMID: 36335294 PMCID: PMC9637312 DOI: 10.1186/s12872-022-02916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
Background Although catheter ablation (CA) is an effective treatment for non-valvular atrial fibrillation (AF), a good many of patients still have a recurrence following post-operation. Prediction of AF recurrence by evaluating left atrial (LA) phase function with speckle tracking echocardiography (STE) may be helpful for risk stratification and clinical management for AF patients. Therefore, the current study aimed to assess the prognostic value of LA strains in non-valvular AF patients after CA. Methods A total of 95 non-valvular AF patients (70.5% paroxysmal AF, 56.8% males, mean age 63.2 ± 9.7 years) were included in this retrospective study between October 2019 and August 2020. Transthoracic echocardiography was performed in all the subjects and STE was used to analyze the LA reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) during different phases before CA. Patients were followed up with until January 2022. The endpoint was AF recurrence. Results Over a median follow-up period of 26.0 months (interquartile range, 24.7–26.7 months), 26 patients experienced recurrence and 69 stayed in sinus rhythm. Compared with no-recurrence group, maximum volume of LA (LAVmax), minimum volume of LA (LAVmin) and LA volume index (LAVI) were increased in the recurrence group, while LAEF, LASr and LASct were worsened (P < 0.05). Multivariable logistic regression analysis revealed that LASct was an independent predictor of AF recurrence (odds ratio, 0.89; 95% confidence interval (CI), 0.82–0.97; P = 0.007) and receiver operating characteristic (ROC) curve analysis showed an area under the curve of LASct<8% was 0.70 (95% CI, 0.59–0.79; P = 0.0008). Conclusions LASct was of independent predictive value of AF recurrence. LA function assessed by STE may contribute to the risk stratification for AF patients and selection of suitable patients for CA.
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Mitral Annular Plane Systolic Excursion (MAPSE) as a Predictor of Atrial Fibrillation Recurrence in Patients after Pulmonary Vein Isolation. Cardiol Res Pract 2022; 2022:2746304. [PMID: 36203496 PMCID: PMC9532161 DOI: 10.1155/2022/2746304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Catheter ablation (CA) with pulmonary vein isolation (PVI) has become widely used in the past years for the treatment of atrial fibrillation (AF). Mitral annular plane systolic excursion (MAPSE) is the parameter that measures left ventricular longitudinal function, and it appears to be a good early marker of LV dysfunction. It is practically independent of poor image quality. The aim of our study was to analyse the role of echocardiographic variables, especially MAPSE in predicting the outcome of CA in patients with AF. Materials and Methods We prospectively included 40 patients with paroxysmal and persistent AF that were referred for CA. All patients underwent radiofrequency CA with PVI. Standard transthoracic two-dimensional echocardiography was conducted one day after CA. Demographic data and the patients' characteristics were noted. The endpoint of our study was to estimate the AF recurrence rate diagnosed by ECG within 6 months of the follow-up period. Results 40 patients, mainly male (67.5%) with an average age of 61.43 ± 8.96 years were included in our study. The majority of patients had paroxysmal AF prior to ablation (77.5%). The AF recurrence rate was 20% after 6 months of follow-up. Lateral MAPSE in the AF-free group was greater than those who relapsed (1.57 ± 0.24 vs. 1.31 ± 0.25; p = 0.012). Patients who remained AF-free after a 6-month follow-up period had a significantly smaller left ventricular volume index (LAVI) than those who relapsed (34.29 ± 6.91 ml/m2 vs. 42.90 ± 8.43 ml/m2; p = 0.05). We found a significant reverse relationship between LAVI and MAPSE (p = 0.020). Conclusion MAPSE and LAVI present risk factors for AF recurrence, specifically reduced MAPSE and larger LAVI, are related to AF recurrence after CA. In the future, MAPSE could play a significant role when predicting the CA outcome in patients with AF.
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Karaliūtė R, Leleika A, Apanavičiūtė I, Kazakevičius T, Mizarienė V, Zabiela V, Kavoliūnienė A, Ragaišytė N, Urbonienė D, Šakalytė G. Risk Factors of Early Atrial Fibrillation Recurrence Following Electrical Cardioversion When Left Ventricular Ejection Fraction Is Preserved. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1053. [PMID: 36013520 PMCID: PMC9416115 DOI: 10.3390/medicina58081053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 11/24/2022]
Abstract
Background and objectives: To identify clinical, echocardiographic, and laboratory parameters that affect the early recurrence of atrial fibrillation (AF) after restoring sinus rhythm (SR) by electrical cardioversion (ECV), and to determine whether left atrial (LA) strain, as a noninvasive indicator reflecting fibrosis, is associated with laboratory indicators affecting the development of fibrosis, interleukin 6 (IL-6) or tumor necrosis factor α (TNF-α). Materials and Methods: The study included 92 persistent AF patients who underwent elective ECV. The effective maintenance of SR was evaluated after 40 ± 10 days of ECV. Echocardiography, inflammatory markers (high-sensitivity c-reactive protein (hs-CRP), IL-6, and TNF-α), and natriuretic peptides (N-terminal pro b-type natriuretic peptide (NT-proBNP) and N-terminal pro a-type natriuretic peptide (NT-proANP)) were assessed. Results: After a 40 ± 10 days observation period, 51 patients (55.4%) were in SR. Patients with AF recurrence had a significantly longer duration of AF (p = 0.008) and of arterial hypertension (p = 0.035), lower LA ejection fraction (p = 0.009), lower LA strain (p < 0.0001), higher left ventricular global longitudinal strain (p = 0.001), and a higher E/e‘ ratio (p < 0.0001). LA strain was an independent predictor of early AF recurrence (OR: 0.65; 95% Cl 0.5−0.9, p = 0.004). LA strain < 11.85% predicted AF recurrence with 70% sensitivity and 88% specificity (AUC 0.855, 95% CI 0.77−0.94, p < 0.0001). LA strain demonstrated the association with NT-proBNP (r = −0.489, p < 0.0001) and NT-proANP (r = −0.378, p = 0.002), as well as with hs-CRP (r = −0.243, p = 0.04). Conclusions: LA strain appeared to be the most accurate predictor of early AF recurrence after ECV in patients with persistent AF. LA strain inversely correlated with NT-proBNP and NT-proANP, but no significant association with any of the inflammatory markers was identified.
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Affiliation(s)
- Rasa Karaliūtė
- Laboratory of Behavioural Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Arnoldas Leleika
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Medicine Faculty, Medicine Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Ieva Apanavičiūtė
- Medicine Faculty, Medicine Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Tomas Kazakevičius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Vaida Mizarienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Aušra Kavoliūnienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Nijolė Ragaišytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Daiva Urbonienė
- Department of Laboratory Medicine, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Gintarė Šakalytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
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12
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Matei LL, Popescu RM, Popescu AC, Bălănescu ȘM. Early Echocardiographic Predictors for Atrial Fibrillation Propensity: The Left Atrium Oracle. Rev Cardiovasc Med 2022; 23:205. [PMID: 39077189 PMCID: PMC11273662 DOI: 10.31083/j.rcm2306205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/13/2022] [Accepted: 04/28/2022] [Indexed: 07/31/2024] Open
Abstract
Atrial fibrillation (AF) results from structural and electrical remodeling of the atria, primarily of the left atrium (LA); therefore, LA changes, both anatomical and functional are recognized as proarrhythmic markers with a powerful prognostic value. Being widely available and noninvasive, echocardiography is used to monitor LA form and function in clinical practice. Early functional (electrical) remodeling of the LA precedes anatomical alterations. Impaired LA functions and reduced atrial compliance due to atrial fibrosis may be evaluated using novel echocardiographic techniques, such as tissue Doppler analysis and speckle tracking. Functional evaluation of the LA conveys prognostic information about the risk of AF, as the severity of the impairment is an independent predictor of new-onset AF and AF recurrence. However, specific parameters are still investigated for incorporation into algorithms to predict future AF occurrence. The aim of the review is to summarize echocardiographic parameters, their predicting value and applicability in practice.
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Affiliation(s)
- Lavinia-Lucia Matei
- Cardiothoracic Medicine Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Roxana-Mihaela Popescu
- Cardiothoracic Medicine Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Andreea Catarina Popescu
- Cardiothoracic Medicine Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Șerban Mihai Bălănescu
- Cardiothoracic Medicine Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
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13
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Ding B, Liu P, Zhang F, Hui J, He L. Predicting Values of Neutrophil-to-Lymphocyte Ratio (NLR), High-Sensitivity C-Reactive Protein (hs-CRP), and Left Atrial Diameter (LAD) in Patients with Nonvalvular Atrial Fibrillation Recurrence After Radiofrequency Ablation. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934569. [PMID: 35082255 PMCID: PMC8805343 DOI: 10.12659/msm.934569] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the predictive values of lipid level, inflammatory biomarkers, and echocardiographic parameters in late NVAF (nonvalvular atrial fibrillation) recurrence after RFA (radiofrequency ablation). MATERIAL AND METHODS This retrospective single-center study enrolled 263 patients with paroxysmal or persistent NVAF who underwent initial RFA from Jan 2017 to Jan 2019. The patients were divided into a Recurrent group (n=70) and a Nonrecurrent group (n=193). Univariate and multivariate logistic regression analyses were used for evaluating the predictive factors of late NVAF recurrence. Receiver operating characteristic (ROC) curves were constructed to assess the predictive performance and the optimum cut-off level of variables. RESULTS Late NVAF recurrence occurred in 70 patients (26.6%) after initial RFA within 12-month follow-up. Patients in the Recurrent group had significant higher NLR (neutrophil-to-lymphocyte ratio), hs-CRP (high-sensitivity C-reactive protein), LVEDD (left ventricular end-diastolic dimension), LVESD (left ventricular end-systolic dimension), and LAD (left atrial diameter) than those in the Nonrecurrent group (P<0.05). In multivariate analysis, increased NLR (HR=1.438, 95% CI: 1.036-1.995, P<0.05), hs-CRP (HR=1.137, 95% CI: 1.029-1.257, P<0.05) and LAD (HR=1.089, 95% CI: 1.036-1.146, P<0.05) were independent predictors of NVAF recurrence. The area under the curve (AUC) of NLR and hs-CRP was 0.603 (95% CI 0.525-0.681) and 0.584 (95% CI 0.501-0.666), respectively. The combination of NLR, hs-CRP, and LAD revealed an AUC of 0.684 (95% CI 0.611-0.757), with cut-off values of 2.33, 2.025 ng/L, and 44.5 mm, respectively. CONCLUSIONS The combination of preoperative NLR, hs-CRP, and LAD can predict late NVAF recurrence.
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Affiliation(s)
- Bing Ding
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Pengfei Liu
- Department of Cardiology, The First People's Hospital of Kunshan, Suzhou, Jiangsu, China (mainland)
| | - Fangfang Zhang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jie Hui
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Linyan He
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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14
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Shchetynska-Marinova T, Kranert M, Baumann S, Liebe V, Grafen A, Gerhards S, Rosenkaimer S, Akin I, Borggrefe M, Hohneck AL. Recurrence of atrial fibrillation after pulmonary vein isolation in dependence of arterial stiffness. Neth Heart J 2021; 30:198-206. [PMID: 34817833 PMCID: PMC8941046 DOI: 10.1007/s12471-021-01644-w] [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] [Accepted: 09/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Arterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Although increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated. Methods Patients with AF who underwent pulmonary vein isolation (PVI) were included in this study. Presence of AS was evaluated by measuring aortic distensibility (AD) of the descending aorta by transoesophageal echocardiography. Results In total, 151 patients (mean ± standard deviation (SD) age 71.9 ± 9.8 years) were enrolled and followed for a median duration of 21 months (interquartile range 15.0–31.0). During follow-up, AF recurred in 94 (62.3%) patients. AF recurrence was seen more frequently in patients with permanent AF (27% vs 46%, p = 0.03) and in those who had undergone prior PVI (9% vs 23%, p = 0.02). AD was significantly reduced in patients with AF recurrence (mean ± SD 2.6 ± 2.3 vs 1.5 ± 0.7 × 10−3 mm Hg−1, p < 0.0001), as well as left atrial volume index (LAVI) (mean ± SD 29 ± 12 vs 44 ± 15 ml/m2, p < 0.0001). Multivariable analysis revealed LAVI (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2–3.4) and AS (OR 3.6, 95% CI 2.8–4.1) as independent risk factors of AF recurrence. Conclusion Increased AS and left atrial size were independent predictors of AF recurrence after PVI. AD as surrogate marker of AS seemed to reflect the overall CV risk. In addition, AD was significantly correlated with left atrial size, which suggests that increased AS leads to atrial remodelling and thus to AF recurrence. Trial registration German registry for clinical studies (DRKS), DRKS00019007. Supplementary Information The online version of this article (10.1007/s12471-021-01644-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Shchetynska-Marinova
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Kranert
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,partner site Mannheim, German Centre for Cardiovascular Research (DZHK), Mannheim, Germany
| | - S Baumann
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - V Liebe
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - A Grafen
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Gerhards
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Rosenkaimer
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - I Akin
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,partner site Mannheim, German Centre for Cardiovascular Research (DZHK), Mannheim, Germany
| | - M Borggrefe
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,partner site Mannheim, German Centre for Cardiovascular Research (DZHK), Mannheim, Germany
| | - A L Hohneck
- First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. .,partner site Mannheim, German Centre for Cardiovascular Research (DZHK), Mannheim, Germany.
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15
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Shchetynska-Marinova T, Liebe V, Papavassiliu T, de Faria Fernandez A, Hetjens S, Sieburg T, Doesch C, Sigl M, Akin I, Borggrefe M, Hohneck A. Determinants of arterial stiffness in patients with atrial fibrillation. Arch Cardiovasc Dis 2021; 114:550-560. [PMID: 33903034 DOI: 10.1016/j.acvd.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Arterial stiffness has emerged as a strong predictor of cardiovascular disease, end-organ damage and all-cause mortality. Although increased arterial stiffness has been described as a predictor of atrial fibrillation, the relationship between arterial stiffness and atrial fibrillation is uncertain. AIM We assessed arterial stiffness in patients with atrial fibrillation compared with that in a control group. METHODS We enrolled 151 patients with atrial fibrillation who underwent pulmonary vein isolation (mean age 71.1±9.8 years) and 54 control patients with similar cardiovascular risk profiles and sinus rhythm, matched for age (mean age 68.6±15.7 years) and sex. Aortic distensibility as a measure of arterial stiffness was assessed by transoesophageal echocardiography. Patients with atrial fibrillation were followed over a median of 21 (15 to 31) months. RESULTS Compared with control patients, patients with atrial fibrillation had significantly lower aortic distensibility (1.8±1.1 vs. 2.1±1.1 10-3mmHg-1; P=0.02). Age (hazard ratio 0.67, 95% confidence interval 0.003 to 0.03; P=0.02) and pulse pressure (hazard ratio -1.35, 95% confidence interval -0.07 to -0.03; P<0.0001) were the strongest predictors of decreased aortic distensibility in the study cohort. This effect was independent of the type of atrial fibrillation (paroxysmal/persistent). During follow-up, decreased aortic distensibility was a predictor of cardiovascular and all-cause hospitalizations, as well as recurrences of atrial fibrillation, with a higher incidence rate of events in patients in the lowest aortic distensibility quartile (P=0.001). CONCLUSIONS Aortic distensibility was significantly reduced in patients with atrial fibrillation, with age and pulse pressure showing the strongest correlation, independent of the type of atrial fibrillation. Additionally, decreased aortic distensibility was associated with cardiovascular and all-cause hospitalizations, as well as recurrences of atrial fibrillation, which showed a quartile-dependent occurrence.
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Affiliation(s)
- Tetyana Shchetynska-Marinova
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Volker Liebe
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Theano Papavassiliu
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Andréa de Faria Fernandez
- Medical faculty of Saarland University, Saarland University Hospital, Clinic for anaesthesiology, intensive medicine and pain therapy, 66421 Homburg/Saar, Germany
| | - Svetlana Hetjens
- Department of biometry and statistics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Tina Sieburg
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Christina Doesch
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Martin Sigl
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Ibrahim Akin
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Martin Borggrefe
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Anna Hohneck
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany.
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16
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Kranert M, Benz ABE, Shchetynska-Marinova T, Hetjens S, Liebe V, Rosenkaimer S, Doesch C, Akin I, Borggrefe M, Hohneck A. Perception of atrial fibrillation in dependence of neuroticism. J Psychosom Res 2020; 138:110225. [PMID: 32877820 DOI: 10.1016/j.jpsychores.2020.110225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Atrial fibrillation (AF) is associated with a varying symptom burden, which ranges from completely unawareness to disabling conditions. The present cross-sectional study tried to assess if neuroticism is associated with a greater degree of perception of AF related symptoms. METHODS 162 patients who were considered for catheter ablation of AF were included. AF related symptom burden was quantified according to the European Heart Rhythm Association (EHRA) score. Personality traits were assessed using the Big Five personality traits (5BT). RESULTS Female patients reported higher symptom burden. Higher EHRA scores were furthermore associated with treatment with antiarrhythmic agents, digitalis, direct oral anticoagulants (DOAC), and antidepressant treatment, as well as suffering from heart failure or chronic kidney disease. Neuroticism showed a positive correlation to AF related symptom burden with significantly higher neuroticism scores in patients with higher EHRA scores (Rho = 0.41; 95%CI 0.26 to 0.53; p < .001), while no association was demonstrated for the other four personality traits. Multiple linear regression analysis revealed neuroticism as strongest independent predictor for symptomatic AF, followed by treatment with antiarrhythmic agents and DOAC. CONCLUSIONS Perception of AF related symptoms is a multifactorial process, which in our cohort was independently associated with neuroticism. Patients with higher symptom burden were also more likely to receive antiarrhythmic agents and DOAC, as well as antidepressants. TRIAL REGISTRATION German registry for clinical studies (DRKS), DRKS00019007.
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Affiliation(s)
- Malte Kranert
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | | | - Tetyana Shchetynska-Marinova
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Svetlana Hetjens
- Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stephanie Rosenkaimer
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christina Doesch
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Anna Hohneck
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
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17
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Kranert M, Shchetynska-Marinova T, Berghoff T, Liebe V, Doesch C, Papavassiliu T, Custodis F, Akin I, Borggrefe M, Hohneck A. Arterial Stiffness Is Associated With Increased Symptom Burden in Patients With Atrial Fibrillation. Can J Cardiol 2020; 36:1949-1955. [PMID: 32891729 DOI: 10.1016/j.cjca.2020.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Increased arterial stiffness (AS) has been described as a predictor of atrial fibrillation (AF). This study was performed to assess whether increased AS leads to a higher symptom burden in patients with AF. METHODS One hundred sixty-two consecutive patients (104 male, 58 female) with diagnosed AF (paroxysmal or persistent) were enrolled. Symptoms most likely attributable to AF were quantified according to the Canadian Cardiovascular Society Severity of Atrial Fibrillation (SAF) scale. AS indices (aortic distensibility, cyclic circumferential strain, and aortic compliance) were characterized using transoesophageal echocardiography. RESULTS The cohort was divided into asymptomatic to oligosymptomatic (SAF scale 0-1, n = 78 [48.1%]) and symptomatic (SAF scale ≥ 2, n = 84 [51.9%]) patients. Symptomatic patients tended to be younger (median, 75 [interquartile range (IQR) 67-80] vs 71 [65-79]; P = 0.047) and were more likely to be female (22 [28.2%] vs 36 [42.9%]; P = 0.052). Hypertension was more frequent in symptomatic patients. Aortic compliance indices each were reduced in symptomatic patients, most pronounced for aortic compliance (median, 0.05 [IQR 0.03-0.06] vs 0.04 [0.03-0.05] cm/mm Hg; P = 0.01) followed by cyclic circumferential strain (median, 0.09 [IQR 0.07-0.11] vs 0.07 [0.04-0.10]; P = 0.02) and aortic distensibility (10-3 mm Hg-1, median, 1.74 [IQR 1.34-2.24] vs 1.54 [1.12-2.08]; P = 0.03). Multivariable analysis revealed aortic compliance as an independent predictor for symptoms in patients with AF with an odds ratio of 2.6 (95% confidence interval, 1.2-3.4; P = 0.003). CONCLUSIONS AS contributes to a high symptom burden in patients with AF, emphasizing the prognostic role of AS in the early detection and prevention in patients with AF.
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Affiliation(s)
- Malte Kranert
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Tetyana Shchetynska-Marinova
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tim Berghoff
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Christina Doesch
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Theano Papavassiliu
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Florian Custodis
- Department of Internal Medicine II, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Ibrahim Akin
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Anna Hohneck
- First Department of Medicine - Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
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Epicardial Fat Volume as a New Imaging-Based Feature Associated with Risk of Recurrence after Pulmonary Veins Ablation in Atrial Fibrillation. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Atrial fibrillation (AF), a common arrhythmia in clinical practice, is associated with a high rate of complications and an increased risk for thromboembolic events. Pulmonary vein ablation is a new therapeutic option to cure AF; however, it remains associated with a high rate of recurrence. In this study we aimed to identify the clinical characteristics and imaging-based features that may predict the risk of recurrence after pulmonary veins ablation in atrial fibrillation.
Materials and method: Twenty-four patients with paroxysmal and persistent AF, who underwent radiofrequency catheter ablation and a 12-month follow-up were included in the study. Group 1 included 8 patients with AF recurrence, and group 2 included 16 patients with no AF recurrence. In all cases, cardiovascular risk factors, ejection fraction, left atrial diameter, atrial volumes, and epicardial fat volume were analyzed.
Results: CT analysis revealed that patients with AF recurrence presented a significantly larger mean index of left atrial volume (59.57 ± 8.52 mL/m2 vs. 49.99 ± 10.88 mL/m2, p = 0.04), right atrial volume (58.94 ± 8.37 mL/m2 vs. 43.21 ± 6.4 mL/m2, p<0.0001), and indexed bi-atrial volume (118.5 ± 15.82 mL/m2 vs. 93.19 ± 16.42 mL/m2, p = 0.005). At the same time, CT analysis of the epicardial adipose tissue volume indicated that patients with AF recurrence have a larger amount of epicardial fat than those without AF recurrence (176.4 ± 100.8 mL vs. 109.8 ± 40.73 mL, p = 0.02).
Conclusion: Left atrial diameter, indexed atrial volumes, and epicardial fat volume may be used as factors to identify patients at risk for developing recurrence after pulmonary vein ablation.
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