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Ahn H, Lim HE, On YK, Selma JM, Kueffer FJ, van Bragt KA, Obidigbo V, Oh IY. Long-term Outcome of Cryoballoon Ablation in Korean Patients With Atrial Fibrillation: Real-world Experience From the Cryo Global Registry. Korean Circ J 2024; 54:54.e62. [PMID: 38956935 DOI: 10.4070/kcj.2024.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF), the most common atrial arrhythmia (AA), is an increasing healthcare burden in Korea. The objective of this sub-analysis of the Cryo Global Registry was to evaluate long-term efficacy, symptom burden, quality of life (QoL), and healthcare utilization outcomes and factors associated with AA recurrence in Korean patients treated with cryoballoon ablation (CBA). METHODS Patients were treated and followed up according to local standard-of-care in 3 Korean hospitals. Kaplan-Meier estimates were used in analyzing (1) efficacy defined as freedom from ≥30 second recurrence of AA at 24 months, (2) healthcare utilization, and (3) predictors of 24-month AA recurrence. Patient-reported QoL (using European Quality of Life-5 Dimensions-3 Levels) and predefined AF-related symptoms were assessed at baseline and 24-month follow-up. RESULTS Efficacy was 71.9% in paroxysmal AF (PAF) and 49.3% in persistent AF (PsAF) patients (p<0.01). A larger left atrial diameter (LAD), an increased time from AF diagnosis to CBA, and PsAF were independent predictors of AA recurrence. The percentage of patients with no AF symptoms significantly increased from baseline (24.5%) to 24-month (89.5%) follow-up (p<0.01). Improvement in QoL from baseline to 24 months was not statistically different between AF cohorts. PAF patients experienced greater freedom from repeat ablations (93.9% vs. 81.4%) and cardiovascular hospitalizations (91.3% vs. 72.5%, p<0.001 for both). CONCLUSIONS In alignment with global outcomes, CBA is an effective treatment for AF in the Korean population, with patients possessing a large LAD and not receiving ablation soon after diagnosis being the most at risk for AA recurrence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02752737.
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Affiliation(s)
- Houngbeom Ahn
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jada M Selma
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, USA
| | - Fred J Kueffer
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, USA
| | | | | | - Il-Young Oh
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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Park JH, Yang DH, Kim JH, Kim YR. Left Atrium Volume Measured with Multislice Computed Tomography as a Prognostic Predictor for Atrial Fibrillation Catheter Ablation Outcomes. J Clin Med 2024; 13:1859. [PMID: 38610624 PMCID: PMC11012873 DOI: 10.3390/jcm13071859] [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: 01/13/2024] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Current guidelines consider atrial fibrillation (AF) type as the prognostic factor for a recommendation of catheter ablation. We aimed to determine whether LA and LA appendage (LAA) volumes measured using multislice computed tomography (MSCT) were related to long-term outcomes in AF following radiofrequency catheter ablation (RFCA). Methods: We evaluated 152 consecutive patients with drug-refractory AF (median age, 55.8 ± 9.6 years), including 110 male patients, who underwent RFCA in a single center. All patients underwent MSCT imaging for anatomical assessment. The endpoint of this study was documented AF recurrence after RFCA. Results: The overall procedure success rate was 77.6% (n = 118) during a mean follow-up period of 12.6 months. The LA volume was significantly larger for those who experienced AF recurrence after RFCA than for the patients without recurrent AF after the procedure (153.8 ± 29.9 mL vs. 139.2 ± 34.1 mL, p = 0.025). However, LAA volumes were nearly equivalent between the patients with and without AF recurrence after RFCA (16.2 ± 6.3 mL and 14.7 ± 6.5 mL, respectively; p = 0.235). LA volume ≥ 153.2 mL was the optimal cutoff value for estimating AF recurrence after RFCA, with 94% sensitivity and 66% specificity. LA volume remained an independent predictor of both AF recurrence and permanent AF. Conclusions: LA volume as assessed by MSCT might be helpful for identifying patients likely to achieve successful AF ablation. LA volume ≥ 153.2 mL, but not LAA volume, showed good accuracy in predicting AF recurrence after RFCA.
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Affiliation(s)
- Jae-Hong Park
- Division of Cardiology, Department of Internal Medicine, Kangnam General Hospital, Yongin 17064, Republic of Korea;
| | - Dong-Hyun Yang
- Department of Radiology, Asan Medical Center, Seoul 05505, Republic of Korea;
| | - Ji-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea;
| | - Yoo-Ri Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chonnam National University, Gwangju 61469, Republic of Korea
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3
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Waranugraha Y, Hsu JC, Lin TT, Ho LT, Yu CC, Liu YB, Lin LY. Novel scoring system derived from meta-analysis and validated in cohort population for predicting 1-year atrial fibrillation recurrence after cryoballoon catheter ablation: The HeLPS-Cryo score. Pacing Clin Electrophysiol 2024; 47:462-473. [PMID: 38400710 DOI: 10.1111/pace.14922] [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: 08/23/2023] [Revised: 11/21/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) recurrence rates in 1 year after cryoballoon ablation catheter (CBCA) are still high. We purposed to identify strong predictors for AF recurrence after the successful CBCA procedure and develop a new scoring system based only on pre-procedural parameters. METHODS In the derivation phase, a systematic review and meta-analysis identified the strong predictors of AF recurrence after the CBCA. The pooled hazard ratio (HR) was used to create the new scoring system. The second phase validated the new scoring system in the cohort population. RESULTS A meta-analysis including 29 cohort studies with 16196 participants confirmed that persistent AF, stroke, heart failure, and left atrial diameter (LAD) >40 mm were powerful predictors for AF recurrence after the CBCA procedure. The HeLPS-Cryo (heart failure [1], left atrial dilatation [1], persistent AF [2], and stroke [2]) was developed based on those pre-procedural predictors. It was validated in 140 patients receiving CBCA procedures and revealed excellent predictive performance for 1-year AF recurrence (AUC = 0.8877; 95% CI = 0.8208 to 0.9546). The HeLPS-Cryo score of ≥3 could predict 1-year AF recurrence with sensitivity and specificity of 78.9% and 87.9%, respectively. The positive predictive value was 66.7%, and the negative predictive value was 93.1%. CONCLUSION The HeLPS-Cryo score can help the physician estimate the probability of 1-year AF recurrence after the successful CBCA procedure. Patients with HeLPS-Cryo score <3 are good candidates for the CBCA procedure.
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Affiliation(s)
- Yoga Waranugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Brawijaya, Universitas Brawijaya Hospital, Malang, Indonesia
| | - Jung-Chi Hsu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Chieh Yu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Bin Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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4
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Song W, Lv T, Zhang N, Li G, Tse G, Liu T. Long-term efficacy and safety of cryoballoon ablation of atrial fibrillation: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2024; 47:49-57. [PMID: 37988273 DOI: 10.1111/pace.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND This meta-analysis evaluated long-term efficacy and safety of cryoballoon ablation (CB) of atrial fibrillation (AF). METHODS PubMed, Cochrane Library, and Web of Science were searched until July 31, 2023, for published works investigating efficacy and safety of CB of AF in which mean/median follow-up time was not less than 36 months. Safety was assessed by adverse events. Efficacy was assessed by AF recurrence, defined as any atrial arrhythmias lasting more than 30 s. RESULTS A total of 19 clinical studies were included. After an average of 58.1 months of follow-up, the overall AF recurrence rate was about 37%. The predictors of recurrence were duration of AF (HR 1.00; 95% CI [1.00 ∼ 1.01]), early recurrence of atrial fibrillation (HR 3.96; 95%CI [1.12 ∼ 14.02]), left atrial diameter (HR 1.04; 95%CI [1.02 ∼ 1.06]), and persistent AF (HR1.47; 95% CI [1.19 ∼ 1.82]). In terms of safety, the incidence of transient phrenic paralysis (PNP) was the highest, about 3%; followed by vascular complications (about 2%); pseudoaneurysm, permanent PNP, and all-cause death was (about 1%); and pericardial effusion and stroke / TIA was very low. CONCLUSION CB is associated with low rates of severe complications and reasonable success rates.
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Affiliation(s)
- Wenhua Song
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tonglian Lv
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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Uslu F. GSM-Net: A global sequence modelling network for the segmentation of short axis CINE MRI images. Comput Med Imaging Graph 2023; 108:102266. [PMID: 37385047 DOI: 10.1016/j.compmedimag.2023.102266] [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: 01/09/2023] [Revised: 05/04/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
Atrial Fibrillation (AF) is a disease where the atria fail to properly contract but quiver instead, due to the abnormal electrical activity of the atrial tissue. In AF patients, anatomical and functional parameters of the left atrium (LA) largely differ from that of healthy people due to LA remodelling, which can continue in many cases after the catheter ablation treatment. Therefore, it is important to follow up with AF patients to detect any recurrence. LA segmentation masks obtained from short-axis CINE MRI images are used as the gold standard for the quantification of LA parameters. Thick slices of CINE MRI images hinder the use of 3D networks for segmentation while 2D architectures often fail to model inter-slice dependencies. This study presents GSM-Net which approximates 3D networks with effective modelling of inter-slice similarities with two new modules: global slice sequence encoder (GSSE) and sequence dependent channel attention module (SdCAt). In contrast to previous work modelling only local inter-slice similarities, GSSE also models global spatial dependencies across slices. SdCAt generates a distribution of attention weights over MRI slices per channel, to better trace characteristic changes in the size of the LA or other structures across slices. We found that GSM-Net outperforms previous methods on LA segmentation and helps to identify AF recurrence patients. We believe that GSM-Net can be used as an automatic tool to estimate LA parameters such as ejection fraction to identify AF, and to follow up with patients after treatment to detect any recurrence.
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Affiliation(s)
- Fatmatülzehra Uslu
- Bursa Technical University, Electrical and Electronics Engineering Department, Bursa, 16310, Türkiye.
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Mechanism and prevention of atrial remodeling and their related genes in cardiovascular disorders. Curr Probl Cardiol 2022; 48:101414. [PMID: 36155200 DOI: 10.1016/j.cpcardiol.2022.101414] [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: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022]
Abstract
Atrial fibrillation (AF) is associated with profound structural and functional changes in the atrium. Inflammation mediated atrial fibrosis is one of the key mechanisms in the pathogenesis of AF. The collagen deposition in extracellular matrix (ECM) is mainly mediated by transforming growth factor β1 (TGF-β1) which promotes AF via controlling smads mediated-collagen gene transcription and regulating the balance of metalloproteinases (MMPs)/ tissue inhibitor of metalloproteinases (TIMPs). Although many processes can alter atrial properties and promote AF, animal models and clinical studies have provided insights into two major forms of atrial remodeling: Atrial tachycardia remodeling (ATR), which occurs with rapid atrial tachyarrhythmia's such as AF and atrial flutter, and atrial structural remodeling (ASR), which is associated with CHF and other fibrosis-promoting conditions. The mechanism of atrial remodeling such as atrial enlargement, ultra structural changes of atrial muscle tissue and myocardial interstitial fibrosis in AF is still unclear. At present, many studies focus on calcium overload, renin angiotensin aldosterone system and transforming growth factor β1, that effect on atrial structural remodeling. Recent experimental studies and clinical investigations have provided structural remodeling is important contributor to the AF. This paper reviews the current understanding of the progresses about mechanism of atrial structural remodeling, and highlights the potential therapeutic approaches aimed at attenuating structural remodeling to prevent AF. Now some recent advancements of this area are reviewed in this paper.
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7
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Lee JH, Hwang I, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Lower pulmonary vein-to-left atrium volume ratio predicts poor rhythm outcome after atrial fibrillation catheter ablation. Front Cardiovasc Med 2022; 9:934168. [PMID: 35911561 PMCID: PMC9334901 DOI: 10.3389/fcvm.2022.934168] [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: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Although left atrial (LA) dimension (LAD) is one of the predictors of atrial fibrillation (AF) recurrence after catheter ablation, repetitive recurrences occur in patients without enlarged LAD. We explored the predictive value of pulmonary vein (PV) to LA volume percent ratio (PV/LA%vol) for rhythm outcomes after AF catheter ablation (AFCA). We included 2913 patients (73.5% male, 60.0 [52.0–67.0] years old, 60.6% paroxysmal AF) who underwent AFCA. We evaluated the association between PV/LA%vol and AF recurrence after AFCA and compared the predictive value for AF recurrences according to the LA size with LAD. We additionally investigated the association between PV/LA%vol and PITX2 gene using a genome-wide association study. LAD affected 1-year recurrence only in the highest tertile group (T3, p = 0.046), but PV/LA%vol determined 1-year recurrence in all LAD groups (T1, p = 0.044; T2, p = 0.021; and T3, p = 0.045). During 20.0 (8.0–45.0) months of follow-up, AF recurrence rate was significantly higher in patients with lower PV/LA%vol (Log-rank p = 0.004, HR 0.91 [0.84–1.00], p = 0.044). In the T1 and T2 LAD groups, predicting AF recurrences was better with PV/LA%vol than with LAD (AUC 0.63 vs. 0.51, p < 0.001 at T1; AUC 0.61 vs. 0.50, p = 0.007 at T2). We replicated PITX2-related rs12646447, which was independently associated with PV/LA%vol (β = 0.15 [0–0.30], p = 0.047). In conclusion, smaller PV volumes after LA volume adjustments have genetic background of PITX2 gene and predictive value for poorer rhythm outcomes after AFCA, especially in patients without LA enlargement.
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Affiliation(s)
- Jae-Hyuk Lee
- Department of Cardiology, Myongji Hospital, Hanyang University Medical Center, Gyeonggi-do, South Korea
| | - Inseok Hwang
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- *Correspondence: Hui-Nam Pak,
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8
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Simon J, El Mahdiui M, Smit JM, Száraz L, van Rosendael AR, Herczeg S, Zsarnóczay E, Nagy AI, Kolossváry M, Szilveszter B, Szegedi N, Nagy KV, Tahin T, Gellér L, van der Geest RJ, Bax JJ, Maurovich-Horvat P, Merkely B. Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation. Clin Cardiol 2021; 45:273-281. [PMID: 34799870 PMCID: PMC8922535 DOI: 10.1002/clc.23748] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/12/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction There are no consistently confirmed predictors of atrial fibrillation (AF) recurrence after catheter ablation. Therefore, we aimed to study whether left atrial appendage volume (LAAV) and function influence the long‐term recurrence of AF after catheter ablation, depending on AF type. Methods AF patients who underwent point‐by‐point radiofrequency catheter ablation after cardiac computed tomography (CT) were included in this analysis. LAAV and LAA orifice area were measured by CT. Uni‐ and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence. Results In total, 561 AF patients (61.9 ± 10.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence‐free time of 22.7 (9.3–43.1) months. Patients with persistent AF had significantly higher body surface area‐indexed LAV, LAAV, and LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment left ventricular ejection fraction (LVEF) <50% (HR = 2.17; 95% CI = 1.38–3.43; p < .001) and LAAV (HR = 1.06; 95% CI = 1.01–1.12; p = .029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF. Conclusion The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF.
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Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lili Száraz
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Szilvia Herczeg
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Emese Zsarnóczay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Anikó Ilona Nagy
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Tamás Tahin
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Sangsriwong M, Cismaru G, Puiu M, Simu G, Istratoaie S, Muresan L, Gusetu G, Cismaru A, Pop D, Zdrenghea D, Rosu R. Formula to estimate left atrial volume using antero-posterior diameter in patients with catheter ablation of atrial fibrillation. Medicine (Baltimore) 2021; 100:e26513. [PMID: 34398006 PMCID: PMC8294916 DOI: 10.1097/md.0000000000026513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/13/2020] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT In patients undergoing atrial fibrillation (AF) ablation, an enlarged left atrium (LA) is a predictor of procedural failure as well as AF recurrence on long term. The most used method to assess LA size is echocardiography-measured diameter, but the most accurate remains computed tomography (CT).The aim of our study was to determine whether there is an association between left atrial diameters measured in echocardiography and the left atrial volume determined by CT in patients who underwent AF ablation.The study included 93 patients, of whom 60 (64.5%) were men and 64 (68.8%) had paroxysmal AF, who underwent AF catheter ablation between January 2018 and June 2019. Left atrial diameters in echocardiography were measured from the long axis parasternal view and the LA volume in CT was measured on reconstructed three-dimensional images.The LA in echocardiography had an antero-posterior (AP) diameter of 45.0 ± 6 mm (median 45; Inter Quartile Range [IQR] 41-49, range 25-73 mm), longitudinal diameter of 67.5 ± 9.4 (median 66; IQR 56-88, range 52-100 mm), and transversal diameter of 42 ± 8.9 mm (IQR 30-59, range 23-64.5 mm). The volume in CT was 123 ± 29.4 mL (median 118; IQR 103-160; range 86-194 mL). We found a significant correlation (r = 0.702; P < .05) between the AP diameter and the LA volume. The formula according to which the AP diameter of the LA can predict the volume was: LA volume = AP diam3 + 45 mL.There is a clear association between the left atrial AP diameter measured on echocardiography and the volume measured on CT. The AP diameter might be sufficient to determine the increase in the volume of the atrium and predict cardiovascular outcomes.
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Affiliation(s)
- Muktapha Sangsriwong
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Puiu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gelu Simu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sabina Istratoaie
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucian Muresan
- Department of Cardiology, Centre Hospitalier Emile Muller, Mulhouse, France
| | - Gabriel Gusetu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, The “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Functional Sciences, Immunology and Allergology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Pop
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dumitru Zdrenghea
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Rosu
- Fifth Department of Internal Medicine, Cardiology-Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Nedios S, Lindemann F, Heijman J, Crijns HJGM, Bollmann A, Hindricks G. Atrial remodeling and atrial fibrillation recurrence after catheter ablation : Past, present, and future developments. Herz 2021; 46:312-317. [PMID: 34223914 DOI: 10.1007/s00059-021-05050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/30/2022]
Abstract
The term "atrial remodeling" is used to describe the electrical, mechanical, and structural changes associated with the presence of an arrhythmogenic substrate for atrial fibrillation. Rhythm control therapy may slow down or even reverse progressive atrial remodeling. Atrial remodeling has long been recognized as an important predictor of clinical outcomes and therapeutic success, but recent advances have highlighted its clinical relevance and revealed the implications of specific anatomical changes such as atrial asymmetry or shape. This has opened the path to computational precision medicine that captures these data in detail and combines them with other factors, to provide patient-specific solutions. The goal of precision medicine lies in improving clinical outcomes, reducing costs, and avoiding unnecessary procedures. In this article, we review the history of atrial remodeling and we summarize the insights from our research on anatomical atrial remodeling and its association with rhythm outcomes after catheter ablation. Finally, we present recent advances in the field, reflecting the beginning of a new technological era that will enable us to improve patient care by personalized patient-specific medicine.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - Frank Lindemann
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Jordi Heijman
- Department of Cardiology, CardiovascularResearch Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, CardiovascularResearch Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
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Altmann S, Halfmann MC, Abidoye I, Yacoub B, Schmidt M, Wenzel P, Forman C, Schoepf UJ, Xiong F, Dueber C, Kreitner KF, Varga-Szemes A, Emrich T. Compressed sensing acceleration of cardiac cine imaging allows reliable and reproducible assessment of volumetric and functional parameters of the left and right atrium. Eur Radiol 2021; 31:7219-7230. [PMID: 33779815 PMCID: PMC8452582 DOI: 10.1007/s00330-021-07830-z] [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] [Received: 08/21/2020] [Revised: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 11/05/2022]
Abstract
Objectives To compare volumetric and functional parameters of the atria derived from highly accelerated compressed sensing (CS)–based cine sequences in comparison to conventional (Conv) cine imaging. Methods CS and Conv cine sequences were acquired in 101 subjects (82 healthy volunteers (HV) and 19 patients with heart failure with reduced ejection fraction (HFrEF)) using a 3T MR scanner in this single-center study. Time-volume analysis of the left (LA) and right atria (RA) were performed in both sequences to evaluate atrial volumes and function (total, passive, and active emptying fraction). Inter-sequence and inter- and intra-reader agreement were analyzed using correlation, intraclass correlation (ICC), and Bland-Altman analysis. Results CS-based cine imaging led to a 69% reduction of acquisition time. There was significant difference in atrial parameters between CS and Conv cine, e.g., LA minimal volume (LAVmin) (Conv 24.0 ml (16.7–32.7), CS 25.7 ml (19.2–35.2), p < 0.0001) or passive emptying fraction (PEF) (Conv 53.9% (46.7–58.4), CS 49.0% (42.0–54.1), p < 0.0001). However, there was high correlation between the techniques, yielding good to excellent ICC (0.76–0.99) and small mean of differences in Bland-Altman analysis (e.g. LAVmin − 2.0 ml, PEF 3.3%). Measurements showed high inter- (ICC > 0.958) and intra-rater (ICC > 0.934) agreement for both techniques. CS-based parameters (PEF AUC = 0.965, LAVmin AUC = 0.864) showed equivalent diagnostic ability compared to Conv cine imaging (PEF AUC = 0.989, LAVmin AUC = 0.859) to differentiate between HV and HFrEF. Conclusion Atrial volumetric and functional evaluation using CS cine imaging is feasible with relevant reduction of acquisition time, therefore strengthening the role of CS in clinical CMR for atrial imaging. Key Points • Reliable assessment of atrial volumes and function based on compressed sensing cine imaging is feasible. • Compressed sensing reduces scan time and has the potential to overcome obstacles of conventional cine imaging. • No significant differences for subjective image quality, inter- and intra-rater agreement, and ability to differentiate healthy volunteers and heart failure patients were detected between conventional and compressed sensing cine imaging. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07830-z.
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Affiliation(s)
- Sebastian Altmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ibukun Abidoye
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Afe Babalola University/Multisystem Hospital, Km 8.5, Afe Babalola way, Ado-Ekiti, Ekiti, Nigeria
| | - Basel Yacoub
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Michaela Schmidt
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Center for Cardiology, Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christoph Forman
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Fei Xiong
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - Christoph Dueber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA.
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A novel predictive model for late recurrence after catheter ablation for atrial fibrillation using left appendage volume measured by cardiac computed tomography. Int J Cardiovasc Imaging 2021; 37:2063-2070. [PMID: 33566262 DOI: 10.1007/s10554-021-02169-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Larger left atrial appendage (LAA) volume is associated with a higher risk of late recurrence (LR) in patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, it is unclear whether LAA volume predicts LR, independent of established risk factors. We sought to evaluate the value of LAA volume in predicting LR after RFCA for AF and to develop a score prediction model including LAA volume for these patients. We retrospectively studied 992 patients who underwent RFCA for AF and cardiac computed tomography before RFCA at a single center. At 3 years after RFCA, 362 patients (36.5 %) experienced recurrence. The multivariate Cox regression model showed that age ≥ 75 years (10 points), non-paroxysmal AF (9 points), diabetes mellitus (4 points), left atrial volume index (1 point per 10 ml/m2 rounded to the nearest integer), and the second (4.7 to < 7 ml/m2; 4 points) and third (≥ 7 ml/m2; 5 points) tertiles of the LAA volume index were independent risk factors LR. The above-mentioned risk factors were included in the integrated score model, and the C-index of the proposed score model was 0.715 (95 % confidence interval [CI] 0.679-0.752). LAA volume is an independent predictor of LR and the predictive model including LAA volume showed good discrimination power. These findings provide evidence for the inclusion of LAA volume in the risk stratification for AF recurrence in patients undergoing RFCA for AF.
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13
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Cardiac Computed Tomography for Atrial Fibrillation Patients Undergoing Ablation: Implications for the Prediction of Early Recurrence. J Thorac Imaging 2021; 35:186-192. [PMID: 31145188 DOI: 10.1097/rti.0000000000000425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to correlate early recurrence of atrial fibrillation (AF) after ablation with noninvasive imaging using cardiac computed tomography (CT). METHODS CT image data of 260 patients who had undergone wide area circumferential ablation (WACA) between October 2005 and August 2010 as well as from 30 subjects in sinus rhythm without a history of AF (control group) were retrospectively analyzed. To evaluate early outcome of AF ablation, all AF patients underwent follow-up with a 30-day event monitor 3 to 4 months after ablation. In addition, a cardiac CT was also performed 3 to 4 months after ablation to exclude pulmonary vein (PV) stenosis. The presence of early AF was correlated with anatomic and functional PV and left atrial parameters, as assessed by cardiac CT. RESULTS A total of 70 patients (26.9%) were found to have early recurrence of AF. However, we found no association between PV or left atrial anatomic or functional parameters derived from cardiac imaging with early AF recurrence. Furthermore, no correlation (P>0.05) between AF recurrence and coronary artery stenosis, anatomic origin of the sinoatrial, or atrioventricular nodal arteries was observed. Finally, PV contraction did not predict AF recurrence. However, when comparing PV contraction in WACA patients with the control group, a significant (P<0.05) reduction in left superior PV and right superior PV contractility was found in patients after radiofreqency ablation. CONCLUSIONS In our relatively large cohort, cardiac CT did not yield any anatomic or functional markers for the prediction of early AF recurrence after undergoing WACA. However, our data may provide insights into functional changes that occur following ablation procedures.
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Kim YG, Boo KY, Choi JI, Choi YY, Choi HY, Roh SY, Shim J, Kim JS, Kim YH. Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:343-351. [PMID: 33516711 DOI: 10.1016/j.jacep.2020.09.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to compare the risk of late recurrence in patients with and without early recurrence. BACKGROUND Early recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) after radiofrequency catheter ablation (RFCA) in AF patients is known to be a transient phenomenon. The theoretical basis of the blanking period is based on such observations. However, the clinical implications of early recurrence need further validation. METHODS Consecutive RFCA cases in a tertiary hospital were analyzed. Early recurrence was defined as any AT or AF event occurring within 90-days post-RFCA. Early recurrence as AT and AF were also analyzed separately. RESULTS A total of 3,120 patients underwent RFCA. Early recurrence occurred in 751 patients (24.1%). Patients who experienced early recurrence had a larger left atrium, worse hemodynamics in the left atrial appendage, and a higher prevalence of nonparoxysmal AF and heart failure. Among patients who experienced early recurrence, 69.6% of patients eventually had late recurrence. Early recurrence was associated with a 4.3- and 3.6-fold increase in the risk of late recurrence after single and multiple procedures, respectively. After multivariate adjustment, early recurrence was an independent risk factor for late recurrence with 3.6- and 2.8-fold increase in the risk of late recurrence after single and multiple procedures, respectively. Early recurrence AT had a lower risk of late recurrence compared with early recurrence AF. CONCLUSIONS Early recurrence was a reliable predictor for late recurrence. The clinical significance of the blanking period in the current guidelines may need to be revisited.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
| | - Ki Yung Boo
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea.
| | - Yun Young Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
| | - Ha Young Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
| | - Jin Seok Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea
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15
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Mangiafico V, Saberwal B, Lavalle C, Raharja A, Ahmed Z, Papageorgiou N, Ahsan S. The role of CT in detecting AF substrate. Trends Cardiovasc Med 2020; 31:457-466. [PMID: 33068722 DOI: 10.1016/j.tcm.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Despite technological advancements and evolving ablation strategies, atrial fibrillation catheter ablation outcome remains suboptimal for a cohort of patients. Imaging-based biomarkers have the potential to play a pivotal role in the overall assessment and prognostic stratification of AF patients, allowing for tailored treatments and individualized care. Alongside consolidated evaluation parameters, novel imaging biomarkers that can detect and stage the remodelling process and correlate it to electrophysiological phenomena are emerging. This review aims to provide a better understanding of the different types of atrial substrate, and how Computed Tomography can be used as a pre-ablation risk stratification tool by assessing the various novel imaging biomarkers, providing a valuable insight into the mechanisms that sustain AF and potentially allowing for a patient-specific ablation strategy.
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Affiliation(s)
- Valentina Mangiafico
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Bunny Saberwal
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Antony Raharja
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Zuhair Ahmed
- Queen Mary University of London, London, England.
| | | | - Syed Ahsan
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
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16
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Du W, Dai M, Wang M, Gong Q, Ye TQ, Wang H, Luo CD. Large left atrial appendage predicts the ablation outcome in hypertensive patients with atrial fibrillation. J Electrocardiol 2020; 63:139-144. [PMID: 33212414 DOI: 10.1016/j.jelectrocard.2020.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clinical outcomes of patients with atrial fibrillation (AF) undergoing catheter ablation can be influenced by many factors. This study sought to investigate whether left atrial appendage (LAA) volume can predict the recurrence of AF after catheter ablation in hypertensive patients. METHODS 108 hypertensive patients(aged 63.1 ± 8.1 years, 53.7% male) with paroxysmal or persistent AF undergoing a first catheter ablation were retrospectively evaluated. Contrast-enhanced cardiac computed tomography (CT) was performed in all enrolled patients prior to ablation for assessment of LAA volume and left atrium (LA) anatomy. Patients were followed up for 12 months to analyze the clinical outcomes after AF catheter ablation. RESULTS 24 patients had AF recurrence after a mean follow-up of 12 months. Patients with AF recurrence (24, 22.2%) exhibited significantly larger (longer) LAA volume, LAA orifice area, LAA orifice short axis, LA volume, LA diameter and higher level of N-terminal proB-type natriuretic peptide (NT-proBNP) compared to those without AF recurrence. LAA volume correlated with type of AF, LA volume, LA diameter and the level of NT-proBNP. Multiple regression analysis demonstrated that LAA volume was an independent predictor of post-ablation AF recurrence in hypertensive patients. Furthermore, LAA volume > 9.99 ml served as a valuable independent predictor of AF recurrence, with a sensitivity of 83.3% and a specificity of 66.7% (area under the curve = 0.733). CONCLUSIONS LAA volume derived from cardiac CT was an independent predictor of AF recurrence after catheter ablation in hypertensive patients.
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Affiliation(s)
- Wei Du
- Department of Cardiology, Mianyang Central Hospital, People's Republic of China
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, People's Republic of China
| | - Min Wang
- Department of Cardiology, Mianyang Central Hospital, People's Republic of China
| | - Qian Gong
- Department of Cardiology, Mianyang Central Hospital, People's Republic of China
| | - Ting-Qiao Ye
- Department of Cardiology, Mianyang Central Hospital, People's Republic of China
| | - Hu Wang
- Department of Cardiology, Mianyang Central Hospital, People's Republic of China
| | - Cai-Dong Luo
- Department of Cardiology, Mianyang Central Hospital, People's Republic of China.
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Morphological and functional parameters of left atrial appendage play a greater role in atrial fibrillation relapse after radiofrequency ablation. Sci Rep 2020; 10:8072. [PMID: 32415245 PMCID: PMC7229104 DOI: 10.1038/s41598-020-65056-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/26/2020] [Indexed: 11/18/2022] Open
Abstract
This study was to quantitatively investigate the role of morphological and functional parameters of the left atrium (LA) and left atrial appendage (LAA) with 256-slice spiral computed tomography (CT) in the recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA). Eighty-three patients with AF who underwent RFA for the first time were divided into the recurrence (n = 27) and non-recurrence (n = 56) groups. All patients underwent a 256-slice spiral CT examination before the operation. The clinical data and quantitative measurement of the morphology and functional parameters of the LA and LAA were analyzed, including the maximal and minimal volume, ejection fraction and volume, and volume strain of LAA and LA (LAAVmax, LAAVmin, LAAEF, LAAEV, and LAA-VS, LAVmax, LAVmin, LAEF, LAEV and LA-VS, respectively). The CHA2DS2-VASc score and the proportion of patients with heart failure were significantly (P < 0.05) higher in the recurrence than non-recurrence group. The LAAVmax, LAAVmin, LAVmax, LAVmin, LAAV and LAV were all significantly greater in the recurrence than non-recurrence group (P < 0.05), and the perimeter, major and minor axes of LAA orifice and LAA depth were also significantly greater in the recurrence than non-recurrence group. The LAAEF, LAEF and LAA-VS were significantly (P < 0.05) lower in the recurrence than non-recurrence group (P < 0.05). Heart failure, CHA2DS2-VASC score, LAEF, LAV, LAAEF and LAA-VS were univariately significant (P < 0.05) risk factors for AF recurrence after ablation. Multivariate analysis revealed LAAEF (HR: 0.790, 95% CI: 0.657–0.950, P = 0.012) and LAAV (HR: 1.160, 95% CI: 1.095–1.229, P <0.001) to be two significant independent predictors of recurrence. ROC curve analysis showed that LAAEF <44.68% had the highest predictive value for recurrence after radiofrequency ablation, with the sensitivity of 90% and specificity of 67.4%, whereas LAA volume >9.25 ml had the highest predictive value for AF recurrence after RFA, with the sensitivity of 85.2% and specificity of 67.9%. In conclusion, the volume of left atrium, volume and morphology of left atrial appendage have all significantly increased while the ejection fraction and volume strain of left atrium and left atrial appendage have both significantly decreased in recurrence than in non-recurrence after radiofrequency ablation. The ejection fraction and volume of left atrial appendage are significant independent predictors of atrial fibrillation recurrence after radiofrequency ablation.
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18
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Clinical and Echocardiographic Risk Factors Predict Late Recurrence after Radiofrequency Catheter Ablation of Atrial Fibrillation. Sci Rep 2019; 9:6890. [PMID: 31053744 PMCID: PMC6499800 DOI: 10.1038/s41598-019-43283-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/16/2019] [Indexed: 11/09/2022] Open
Abstract
The benefits of radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) significantly decrease with late recurrence (LR). We aimed to develop a scoring system to identify patients at high and low risk for LR following RFCA, based on a comprehensive evaluation of multiple risk factors for AF recurrence, including echocardiographic parameters. We studied 2,352 patients with AF undergoing first-time RFCA in a single institution. The LR-free survival rate up to 5 years was measured using a Kaplan-Meier analysis. The influence of clinical and echocardiographic parameters on LR was calculated with a Cox-regression analysis. Duration of AF ≥4 years (hazard ratio [HR] = 1.75; p < 0.001), non-paroxysmal AF (HR = 3.18; p < 0.001), and diabetes (HR = 1.34; p = 0.015) were associated with increased risk of LR. Left atrial (LA) diameter ≥45 mm (HR = 2.42; p < 0.001), E/e' ≥ 10 (HR = 1.44; p < 0.001), dense SEC (HR = 3.30; p < 0.001), and decreased LA appendage flow velocity (≤40 cm/sec) (HR = 2.35; p < 0.001) were echocardiographic parameters associated with increased risk of LR following RFCA. The LR score based on the aforementioned risk factors could be used to predict LR (area under curve = 0.717) and to stratify the risk of LR (HR = 1.45 per 1 point increase in the score; p < 0.001). In conclusion, LR after RFCA is affected by multiple clinical and echocardiographic parameters. This study suggests that combining these multiple risk factors enables the identification of patients with AF at high or low risk for having arrhythmia recurrence.
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Denham NC, Pearman CM, Caldwell JL, Madders GWP, Eisner DA, Trafford AW, Dibb KM. Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure. Front Physiol 2018; 9:1380. [PMID: 30337881 PMCID: PMC6180171 DOI: 10.3389/fphys.2018.01380] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) is commonly associated with heart failure. A bidirectional relationship exists between the two-AF exacerbates heart failure causing a significant increase in heart failure symptoms, admissions to hospital and cardiovascular death, while pathological remodeling of the atria as a result of heart failure increases the risk of AF. A comprehensive understanding of the pathophysiology of AF is essential if we are to break this vicious circle. In this review, the latest evidence will be presented showing a fundamental role for calcium in both the induction and maintenance of AF. After outlining atrial electrophysiology and calcium handling, the role of calcium-dependent afterdepolarizations and atrial repolarization alternans in triggering AF will be considered. The atrial response to rapid stimulation will be discussed, including the short-term protection from calcium overload in the form of calcium signaling silencing and the eventual progression to diastolic calcium leak causing afterdepolarizations and the development of an electrical substrate that perpetuates AF. The role of calcium in the bidirectional relationship between heart failure and AF will then be covered. The effects of heart failure on atrial calcium handling that promote AF will be reviewed, including effects on both atrial myocytes and the pulmonary veins, before the aspects of AF which exacerbate heart failure are discussed. Finally, the limitations of human and animal studies will be explored allowing contextualization of what are sometimes discordant results.
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Affiliation(s)
- Nathan C. Denham
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | | | | | | | | | | | - Katharine M. Dibb
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Lambert L, Marek J, Fingrova Z, Havranek S, Kuchynka P, Cerny V, Simek J, Burgetova A. The predictive value of cardiac morphology for long-term outcome of patients undergoing catheter ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2018; 12:418-424. [PMID: 29945850 DOI: 10.1016/j.jcct.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Catheter ablation (CA) is an established therapy for selected patients with atrial fibrillation (AF), but predictors of CA ablation outcome are still not fully elucidated. The aim of the study was to identify structural and morphological parameters from computed tomography (CT) as predictors of successful CA of AF in a single center prospective cohort. METHODS An analysis of CT scans dedicated to LA evaluation was performed in 99 patients (63 ± 8 years old, 70% males, 59% paroxysmal AF) scheduled for CA of AF. Survival free of atrial fibrillation/flutter/tachycardia at 1- and 3-years was assessed. RESULTS In overall study population, both 1- and 3-year responders had smaller distance to the first division in left superior pulmonary vein (16.3 ± 5.42 mm vs. 19.1 ± 7.0 mm and 14.9 ± 3.6 mm vs. 18.7 ± 7.0 mm; p < 0.05). One-year responders had larger ostium area of left inferior pulmonary vein (median 236 mm2 [IQR = 97] vs. 222 mm2 [IQR = 71]; p = 0.03) and less acute angle between the interatrial septum and the right superior pulmonary vein (102 ± 20° vs. 95 ± 10°; p = 0.03). Three-years' responders had smaller ostium area of the right superior pulmonary vein (248 ± 94 mm2 vs. 364 ± 282 mm2; p = 0.02). Multivariate Cox regression analysis identified different predictors in paroxysmal and non-paroxysmal AF. For patients with paroxysmal AF, the predictors were angle to right superior pulmonary vein and left superior/inferior pulmonary veins carina thickness with hazard ratios of 0.965 (95%CI 0.939 to 0.992, p = 0.010) and 0.747 (95%CI 0.591 to 0.944, p = 0.015). In patients with persistent AF, the predictors were gender and NYHA stage with hazard ratios of 4.9 (95%CI 1.758 to 13.579, p = 0.002) and 0.365 (95%CI 0.148 to 0.899, p = 0.028) respectively. CONCLUSIONS The anatomy of LA, especially morphology of pulmonary veins, seems to be one of the predictors of clinical outcome after CA for paroxysmal AF. In non-paroxysmal AF LA anatomy is less relevant in prediction of clinical outcome.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Josef Marek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Zdenka Fingrova
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Stepan Havranek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
| | - Petr Kuchynka
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Vladimir Cerny
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jan Simek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
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21
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Kornej J, Schumacher K, Husser D, Hindricks G. [Biomarkers and atrial fibrillation : Prediction of recurrences and thromboembolic events after rhythm control management]. Herzschrittmacherther Elektrophysiol 2018; 29:219-227. [PMID: 29761335 DOI: 10.1007/s00399-018-0558-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical praxis and is associated with an increased risk for cardio- and cerebrovascular complications leading to an increased mortality. Catheter ablation represents one of the most important and efficient therapy strategies in AF patients. Nevertheless, the high incidence of arrhythmia recurrences after catheter ablation leads to repeated procedures and higher treatment costs. Recently, several scores had been developed to predict rhythm outcomes after catheter ablation. Biomarker research is also of enormous interest. There are many clinical and blood biomarkers pathophysiologically associated with AF occurrence, progression and recurrences. These biomarkers-including different markers in blood (e. g. von Willebrand factor, D‑dimer, natriuretic peptides) or urine (proteins, epidermal grown factor receptor) but also cardiac imaging (echocardiography, computed tomography, magnetic resonance imaging)-could help to improve clinical scores and be useful for individualized AF management and optimized patients' selection for different AF treatment strategies. In this review, the role of diverse biomarkers and their predictive value related to AF-associated complications are discussed.
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Affiliation(s)
- Jelena Kornej
- Abteilung für Rhythmologie, Herzzentrum Leipzig, HELIOS Kliniken GmbH, Strümpellstraße 39, 04289, Leipzig, Deutschland.
| | - Katja Schumacher
- Abteilung für Rhythmologie, Herzzentrum Leipzig, HELIOS Kliniken GmbH, Strümpellstraße 39, 04289, Leipzig, Deutschland
| | - Daniela Husser
- Abteilung für Rhythmologie, Herzzentrum Leipzig, HELIOS Kliniken GmbH, Strümpellstraße 39, 04289, Leipzig, Deutschland
| | - Gerhard Hindricks
- Abteilung für Rhythmologie, Herzzentrum Leipzig, HELIOS Kliniken GmbH, Strümpellstraße 39, 04289, Leipzig, Deutschland
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Shiozawa T, Shimada K, Sekita G, Hayashi H, Tabuchi H, Miura S, Fujimoto S, Kadoguchi T, Ouchi S, Aikawa T, Al Shahi H, Takahashi S, Miyazaki T, Sumiyoshi M, Nakazato Y, Daida H. Left Atrial Appendage Volume and Plasma Docosahexaenoic Acid Levels Are Associated With Atrial Fibrillation Recurrence After Catheter Ablation. Cardiol Res 2017; 8:96-104. [PMID: 28725325 PMCID: PMC5505292 DOI: 10.14740/cr542w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/19/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Risk factors for atrial fibrillation (AF) recurrence in patients who have undergone AF catheter ablation have not been fully clarified. The objective of this study was to assess whether the left atrium (LA) and LA appendage (LAA) volumes, and cardio-metabolic markers such as polyunsaturated fatty acids (PUFAs) levels were associated with AF recurrence. METHODS Seventy-seven consecutive patients with AF (mean age, 59 ± 8 years; male, 81%; paroxysmal AF, 64%) undergoing catheter ablation were enrolled. Using contrast-enhanced cardiac multi-detector computed tomography (MDCT) scan, the LA and LAA volume and orifice area were assessed. Radiofrequency ablation was performed by an irrigation catheter, initially targeting the pulmonary veins with a wide area circumferential ablation. RESULTS Patients with AF recurrence (36%) exhibited both larger LAA volumes and an LAA orifice area than those without AF recurrence, whereas the LA diameter and LA volumes were not significantly different. Notably, AF recurrence occurred in all patients with a large LAA (≥ 25 mL), and the LAA volume was significantly and negatively associated with docosahexaenoic acid (DHA) levels (β = -0.33, P = 0.003). A multiple regression analysis revealed that the log N-terminal proB-type natriuretic peptide and plasma DHA levels were independent factors for the LAA volume when adjusted for age, AF detected age, left ventricular (LV) ejection fraction, end-systolic LV diameter. CONCLUSIONS These results suggest that the association between LAA volume and low plasma DHA levels may be an important factor for post-ablation AF recurrence.
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Affiliation(s)
- Tomoyuki Shiozawa
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Gaku Sekita
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haruna Tabuchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seiji Miura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoyasu Kadoguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hamad Al Shahi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuhei Takahashi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuro Miyazaki
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masataka Sumiyoshi
- Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yuji Nakazato
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Pinto Teixeira P, Martins Oliveira M, Ramos R, Rio P, Silva Cunha P, Delgado AS, Pimenta R, Cruz Ferreira R. Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation. J Interv Card Electrophysiol 2017; 49:165-171. [PMID: 28567579 DOI: 10.1007/s10840-017-0256-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/15/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Recurrence of atrial fibrillation (AF) after catheter ablation is common, being clinically relevant to identify predictors of recurrence. The left atrial appendage (LAA) role as an AF trigger is scarcely explored. Our aim was to identify if LAA volume is an independent predictor of AF recurrence after catheter ablation. METHODS We analysed 52 patients (aged 54 ± 10 years, 58% male) with paroxysmal and persistent AF who underwent a first AF catheter ablation and had performed contrast-enhanced cardiac computed tomography (CT) prior to the procedure. RESULTS The mean left atrial and LAA volumes measured by cardiac CT were 98.9 ± 31.8 and 9.3 ± 3.5 mL, respectively. All patients received successful pulmonary vein isolation and were followed up for 24 months. AF recurrence occurred in 17 patients (33%). LAA volume was significantly greater in patients with AF recurrence than in those without recurrence (11.3 ± 2.9 vs. 8.2 ± 3.4 mL; p = 0.002). Multivariable analysis using Cox regression revealed that LAA volume (hazard ratio 1.32; 95% confidence interval 1.12-1.55; p = 0.001) and persistent AF (hazard ratio 4.22; 95% confidence interval 1.48-12.07; p = 0.007) were independent predictors for AF recurrence. An LAA volume greater than 8.825 mL predicted AF recurrence with 94% sensitivity and 66% specificity. The Kaplan-Meier analysis showed a lower rate free from AF recurrence in the group with an LAA volume >8.825 mL (p < 0.001). CONCLUSIONS Larger LAA volume was associated with AF recurrence after catheter ablation in patients with paroxysmal and persistent AF.
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Affiliation(s)
- Pedro Pinto Teixeira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal.
| | - Mário Martins Oliveira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal
| | - Ruben Ramos
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal
| | - Pedro Rio
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal
| | - Pedro Silva Cunha
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal
| | - Ana Sofia Delgado
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal
| | - Ricardo Pimenta
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta 50, 1169-024, Lisbon, Portugal
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Njoku A, Kannabhiran M, Arora R, Reddy P, Gopinathannair R, Lakkireddy D, Dominic P. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace 2017; 20:33-42. [DOI: 10.1093/europace/eux013] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/21/2017] [Indexed: 11/13/2022] Open
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Left Atrial Reverse Remodeling. JACC Cardiovasc Imaging 2017; 10:65-77. [DOI: 10.1016/j.jcmg.2016.11.003] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 12/12/2022]
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26
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State-of-the-Art CT Imaging of the Left Atrium. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Buist TJ, Gal P, Ottervanger JP, Smit JJJ, Ramdat Misier AR, Delnoy PPHM, Adiyaman A, Jager PL, Elvan A. Association between pulmonary vein orientation and ablation outcome in patients undergoing multi-electrode ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2016; 10:251-7. [DOI: 10.1016/j.jcct.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 12/07/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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28
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Thosani AJ, Gerczuk P, Liu E, Belden W, Moraca R. Closed Chest Convergent Epicardial-Endocardial Ablation of Non-paroxysmal Atrial Fibrillation - A Case Series and Literature Review. Arrhythm Electrophysiol Rev 2016; 2:65-8. [PMID: 26835043 DOI: 10.15420/aer.2013.2.1.65] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The closed chest convergent procedure is a multidisciplinary approach to atrial fibrillation (AF) treatment. Epicardial posterior left atrial (PLA) ablation is performed by a cardiac surgeon using a transdiaphragmatic endoscope, immediately followed by percutaneous pulmonary vein (PV) isolation performed by a cardiac electrophysiologist. Interim outcomes for the treatment of non-paroxysmal AF (NPAF) were evaluated based on peri-procedural safety and complications, freedom from recurrent AF, and need for cardioversion or repeat catheter ablation at three, six and 12 months post-procedure. A total of 43 patients (86 % NPAF) underwent the convergent procedure. Patients were 84 % male, with mean age 58.6 ± 8.7 years. Mean AF duration was 45.4 ± 40.3 months. Pre-procedure left atrium (LA) volumetric data using cardiac magnetic resonance imaging (MRI) or computed tomography (CT) was available for 30 patients (70 %). Average LA volume was 155.5 ± 48.4 millilitres (ml); two-thirds of patients had a LA volume >130 ml. There was no operative or peri-operative mortality. Sinus rhythm (SR) was recorded at three months in 31 of 39 (79 %) patients, at six months in 24 of 27 (89 %) patients and at 12 months in nine patients. The convergent procedure is a safe and effective option for both PV isolation and PLA substrate ablation in NPAF patients. Long-term follow-up is required and randomised clinical trials warranted.
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Affiliation(s)
| | | | | | | | - Robert Moraca
- Division of Cardiothoracic Surgery, Allegheny General Hospital, Pennsylvania, US
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McKinnie J. The Convergent Procedure - A Standardised and Anatomic Approach Addresses the Clinical and Economic Unmet Needs of the Persistent Atrial Fibrillation Population. Arrhythm Electrophysiol Rev 2016; 2:145-8. [PMID: 26835056 DOI: 10.15420/aer.2013.2.2.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A standardised treatment management approach is needed to address the escalating worldwide prevalence of atrial fibrillation (AF). The persistent and longstanding persistent AF patient population particularly needs this standardised treatment option to manage their AF. These patients have underlying structural heart disease that result in increased hospitalizations, long-term medical management that increases the cost burden of the healthcare system. Approximately 100 patients have undergone the Convergent Procedure at our center since its introduction 2 years ago, as a treatment option for AF patients. The epicardial and endocardial ablation procedures performed sequentially in a single setting has shown a single procedure success rate of 80%, similar to published success rates at other centers. The epicardial posterior wall isolation silences a majority of known substrates and the endocardial procedure completes the pulmonary vein isolation, creates the cavotricuspid line and provides diagnostic confirmation. The Convergent Procedure should be considered as a first line treatment option for the persistent and longstanding persistent AF patient population who have very limited or no treatment options for the long-term successful management of their AF.
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Affiliation(s)
- James McKinnie
- East Jefferson General Hospital, Metairie, Louisiana, US
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30
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Hauser TH, Essebag V, Baldessin F, McClennen S, Yeon SB, Manning WJ, Josephson ME. Prognostic value of pulmonary vein size in prediction of atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2015; 17:49. [PMID: 26082185 PMCID: PMC4470356 DOI: 10.1186/s12968-015-0151-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/01/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The relationship between pulmonary vein (PV) anatomy and successful catheter ablation of atrial fibrillation (AF) is poorly understood METHODS First-pass contrast enhanced PV magnetic resonance angiography was performed in 71 consecutive patients prior to PV isolation. PV diameter and cross-sectional area (CSA) were measured prior to PV isolation. Any symptomatic or asymptomatic AF >10s was considered a recurrence. Early recurrence was defined as recurrent AF ≤30 days after PV isolation, while late recurrence of AF was defined as recurrent AF >30 days after. RESULTS At 1 year, 57% had any recurrence of AF while 41% had late recurrence of AF. Study subjects with one or more PV diameter in the top 10(th) percentile had trend toward more early recurrent AF (HR 1.99, p = 0.053). Study subjects with one or more PV CSA in the top 10th percentile had more late recurrent AF (HR 2.25, p = 0.039) and a trend toward more early recurrent AF (HR 1.94, p = 0.064). With multivariate analysis, PV size was not associated with early recurrent AF, but late recurrent AF was associated with one or more large PV, increased left atrial size, and non-paroxysmal AF. Study subjects with all three of these risk factors had a 100% rate of late recurrent AF at 1 year, while those with none had a 7% rate of late recurrent AF. CONCLUSIONS Larger PV size is independently associated with more late recurrent AF after PV isolation. Determination of PV size prior to PV isolation may predict procedural success.
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Affiliation(s)
- Thomas H. Hauser
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
| | - Vidal Essebag
- />Division of Cardiology, McGill University Health Center, Montreal, Canada
| | | | - Seth McClennen
- />Harbor Medical Associates, South Weymouth, Massachusetts
| | - Susan B. Yeon
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
- />Division of Cardiology, McGill University Health Center, Montreal, Canada
- />Azienda Ospedaliera Treviso, Treviso, Italy
- />Harbor Medical Associates, South Weymouth, Massachusetts
- />UpToDate, Waltham, Massachusetts
- />Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Warren J. Manning
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
- />Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark E. Josephson
- />Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RW-453, Boston, 02215 Massachusetts
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Abstract
PURPOSE OF REVIEW This review of emerging approaches to left atrial imaging in atrial fibrillation is relevant because there has been considerable recent development in the noninvasive characterization of left atrial structure and function. Concurrently, the identification and treatment of atrial fibrillation and the prevention of thromboembolism are evolving. Thus, it is timely to summarize how the advances in these two areas might be synergistic in the treatment of atrial fibrillation. RECENT FINDINGS This article will summarize recent developments in left atrial imaging that play a role in patients with atrial fibrillation, with particular emphasis on echocardiography, and with reference made to important advances in cardiac computed tomography and cardiac magnetic resonance. The evidence that these modalities can predict who will develop atrial fibrillation, who will achieve sustained sinus rhythm after cardioversion or catheter ablation, and who will have thromboembolic risk will be reviewed. SUMMARY Although existing evidence is promising, the clinical role of cardiac imaging to predict atrial fibrillation occurrence, atrial fibrillation recurrence after treatment, and thromboembolism from atrial fibrillation remains to be confirmed in large-scale studies and clinical trials.
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Nedios S, Kosiuk J, Koutalas E, Kornej J, Sommer P, Arya A, Richter S, Rolf S, Husser D, Hindricks G, Bollmann A. Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2015; 43:237-44. [DOI: 10.1007/s10840-015-0010-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation. Int J Cardiol 2015; 184:56-61. [DOI: 10.1016/j.ijcard.2015.01.060] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/30/2014] [Accepted: 01/25/2015] [Indexed: 11/17/2022]
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Gal P, Ooms JFW, Ottervanger JP, Smit JJJ, Adiyaman A, Ramdat Misier AR, Delnoy PPHM, Jager PL, Elvan A. Association between pulmonary vein orientation and atrial fibrillation-free survival in patients undergoing endoscopic laser balloon ablation. Eur Heart J Cardiovasc Imaging 2015; 16:799-806. [DOI: 10.1093/ehjci/jeu321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/18/2014] [Indexed: 11/14/2022] Open
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Aytemir K, Gurses KM, Yalcin MU, Kocyigit D, Dural M, Evranos B, Yorgun H, Ates AH, Sahiner ML, Kaya EB, Oto MA. Safety and efficacy outcomes in patients undergoing pulmonary vein isolation with second-generation cryoballoon. Europace 2014; 17:379-87. [DOI: 10.1093/europace/euu273] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Bardia A, Montealegre-Gallegos M, Mahmood F, Owais K, Pal A, Matyal R. Left atrial size: an underappreciated perioperative cardiac risk factor. J Cardiothorac Vasc Anesth 2014; 28:1624-32. [PMID: 25307502 DOI: 10.1053/j.jvca.2014.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Amit Bardia
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mario Montealegre-Gallegos
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Hospital México C.C.S.S., Universidad de Costa Rica, San José, Costa Rica
| | - Feroze Mahmood
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Khurram Owais
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Anam Pal
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Global left atrial strain in the prediction of sinus rhythm maintenance after catheter ablation for atrial fibrillation. J Am Soc Echocardiogr 2014; 27:1184-92. [PMID: 25260436 DOI: 10.1016/j.echo.2014.08.017] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Left atrial (LA) strain is a sensitive measure of LA mechanics. However, its relationship with rhythm outcomes after catheter ablation in patients with atrial fibrillation (AF) is not well established. The aim of this study was to evaluate whether baseline LA global longitudinal strain (LAε) predicts rhythm outcomes in patients who undergo catheter ablation for AF. METHODS In 256 patients with AF (paroxysmal, 204; persistent, 52), comprehensive echocardiography was performed with assessment of LAε by using Velocity Vector Imaging to calculate average strain values from apical four- and two-chamber views before ablation (median, 41 days; interquartile range, 1-95 days). RESULTS After a median of 8.0 months (interquartile range, 4.0-23.3 months) of follow-up, 149 patients (58%) had maintained sinus rhythm and 107 patients (42%) had recurrence of AF. In our study cohort (mean age 59 ± 11 years; mean left ventricular ejection fraction, 58 ± 10%), impaired total LAε (LAεtotal) was associated with greater left ventricular mass index (r = -0.245, P < .001) and worsening left ventricular diastolic function (ratio of transmitral flow peak early diastolic velocity to peak early diastolic velocity of the mitral annulus: r = -0.357, P < .001; maximal LA volume index: r = -0.393, P < .001). Patients with LAεtotal < 23.2% showed a higher incidence of AF recurrence compared with patients with LAεtotal ≥ 23.2% (log-rank P < .001). In multivariate Cox proportional-hazards analysis, LAεtotal was independently related to rhythm outcomes (hazard ratio, 0.944; 95% confidence interval, 0.915-0.975; P < .001) after AF ablation. Moreover, LAεtotal provided incremental predictive value for rhythm outcomes over clinical features (increment in global χ(2) = 14.63, P < .001). CONCLUSIONS In patients with AF, baseline LAεtotal was associated with rhythm outcome after catheter ablation.
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Ejima K, Arai K, Suzuki T, Kato K, Yoshida K, Nuki T, Suzuki F, Uematsu S, Fukushima K, Hoshi H, Manaka T, Ashihara K, Shoda M, Hagiwara N. Long-term outcome and preprocedural predictors of atrial tachyarrhythmia recurrence following pulmonary vein antrum isolation-based catheter ablation in patients with non-paroxysmal atrial fibrillation. J Cardiol 2014; 64:57-63. [DOI: 10.1016/j.jjcc.2013.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/24/2013] [Accepted: 11/09/2013] [Indexed: 10/25/2022]
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Kornej J, Husser D, Bollmann A, Lip GYH. Rhythm outcomes after catheter ablation of atrial fibrillation. Clinical implication of biomarkers. Hamostaseologie 2013; 34:9-19. [PMID: 24166596 DOI: 10.5482/hamo-13-09-0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022] Open
Abstract
Atrial fibrillation (AF) occurs as the result of numerous complex physiological processes in the atria leading to AF promotion and maintenance. Improved diagnostic techniques have identified various biomarkers which may play an important role in the prediction of AF related outcomes (cardio- and cerebrovascular events, as well as mortality and rhythm outcomes). Biomarkers refer to 'biological markers' and biomarkers in blood, urine as well as imaging marker (eg, dimensions (left atrial diameter and volume), anatomical features (left appendage and pulmonary vein anatomy), and physiological pattern (LAA flow velocity)) may play important role(s) as clinically important indices in relation to outcomes after different therapeutic strategies. However, the main domain in the biomarker field has focused on blood-based biomarkers, which are widely used to predict therapeutic success regarding underlying pathophysiological mechanism, such as inflammation, fibrosis, endothelial damage. This review provides an update of the role of clinically relevant biomarkers in AF, with particular focus on AF rhythm outcomes.
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Affiliation(s)
| | | | | | - G Y H Lip
- Prof. Gregory Y. H. Lip, Centre for Cardiovascular Sciences, University of Birmingham City Hospital, Birmingham, United Kingdom, E-mail:
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Amin V, Finkel J, Halpern E, Frisch DR. Impact of left atrial volume on outcomes of pulmonary vein isolation in patients with non-paroxysmal (persistent) and paroxysmal atrial fibrillation. Am J Cardiol 2013; 112:966-70. [PMID: 23831160 DOI: 10.1016/j.amjcard.2013.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 11/28/2022]
Abstract
Using a novel graded outcomes scale, the investigators evaluated whether left atrial (LA) volume measured by cardiac computed tomographic angiography is a predictor of pulmonary vein isolation success in patients with nonparoxysmal atrial fibrillation (AF) and paroxysmal AF (PAF). Data from 45 patients who underwent electrocardiographically gated computed tomographic angiography before pulmonary vein isolation for AF were used. LA volume was measured in the ventricular systolic and diastolic phases, defined as 40% and 75% of the interval between consecutive R waves. Outcomes were graded at 0 to 3, 3 to 6, 6 to 12, and 12 to 24 months after pulmonary vein isolation and scored on a 5-point scale: 1 = no AF recurrence off antiarrhythmic drug, 2 = no AF recurrence on antiarrhythmic drug, 3 = rare AF (<1 episode in 3 months), 4 = asymptomatic recurrent AF, and 5 = no reductions in AF frequency or severity. LA volumes were significantly larger in the nonparoxysmal AF group compared with the PAF group in systole (159.2 vs 128.2 ml, p <0.001) and diastole (137.1 vs 104.0 ml, p <0.001). In patients with PAF, larger LA volume was correlated with worse clinical outcomes in the first 12 months, but the results did not reach statistical significance (systole r = 0.25 to 0.41, diastole r = 0.20 to 0.34). In conclusion, these results show a significant difference in LA volume in patients with nonparoxysmal AF and PAF in systole and diastole. Additionally, there was a correlation between LA volume and clinical outcomes in patients with PAF, although this did not reach statistical significance.
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Affiliation(s)
- Vaibhav Amin
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Yamaguchi T, Tsuchiya T, Nagamoto Y, Miyamoto K, Murotani K, Okishige K, Takahashi N. Long-term results of pulmonary vein antrum isolation in patients with atrial fibrillation: an analysis in regards to substrates and pulmonary vein reconnections. Europace 2013; 16:511-20. [PMID: 24078342 DOI: 10.1093/europace/eut265] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To examine the impact of left atrial (LA) low-voltage zones (LVZs) on atrial fibrillation (AF) recurrence after pulmonary vein antrum isolation (PVAI) without LA substrate modification. METHODS AND RESULTS Seventy-six patients with AF (paroxysmal/persistent 65/11) were prospectively enroled. Left atrial voltage maps were constructed during sinus rhythm using NavX to identify LVZs (<0.5 mV), and PVAI without any LA substrate modification was performed using an open-irrigation catheter. After PVAI, 20 mg of adenosine triphosphate (ATP) was injected. Adenosine triphosphate-induced PV reconnections were eliminated by touch-up ablation when unmasked. Voltage maps revealed LVZs in 24 patients (32%) and no LVZs in 52 (68%). During 24 ± 7 months of follow-up, 15 patients (63%) with LVZs and 10 (19%) without had AF recurrences off antiarrhythmic drugs (log-rank P < 0.001). A multivariate logistic regression analysis revealed that LVZ areas [odds ratio (OR): 1.12 per 1 cm(2), 95% confidence interval (CI): 1.04-1.23, P = 0.001] and ATP-induced reconnection (OR: 2.08, 95% CI: 1.01-4.91, P = 0.046) were significant predictors of recurrence. In those with LVZs, the LVZ area was strongly correlated with the LA body volume (r = 0.81, P < 0.001) and a unique predictor of recurrence (OR: 1.17 per 1 cm(2), 95% CI: 1.01-1.55, P = 0.031), while in those without an LVZ, ATP-induced PV reconnection was a unique predictor (OR: 3.24, 95% CI: 1.15-15.39, P = 0.025). CONCLUSION The LVZ area was an independent predictor of recurrence after PVAI without any LA substrate modification. Adenosine triphosphate-induced PV reconnection was also an independent predictor, especially in those without LVZs.
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Fredersdorf S, Ucer E, Jungbauer C, Dornia C, Eglmeier J, Eissnert C, Hamer OW, Weber S, Arzt M, von Bary C. Lone atrial fibrillation as a positive predictor of left atrial volume reduction following ablation of atrial fibrillation. Europace 2013; 16:26-32. [DOI: 10.1093/europace/eut152] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sohns C, Sohns JM, Vollmann D, Lüthje L, Bergau L, Dorenkamp M, Zwaka PA, Hasenfuß G, Lotz J, Zabel M. Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation. Eur Heart J Cardiovasc Imaging 2013; 14:684-91. [PMID: 23435593 DOI: 10.1093/ehjci/jet017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS This study aimed to identify whether left atrial (LA) volume assessed by multidetector computed tomography (MDCT) is related to the long-term success of pulmonary vein ablation (PVA). MDCT is used to guide PVA for the treatment of atrial fibrillation (AF). MDCT permits accurate sizing of LA dimensions. METHODS AND RESULTS We analysed data from 368 ablation procedures of 279 consecutive patients referred for PVA due to drug-refractory symptomatic AF (age 62 ± 10; 58% men; 71% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 64-MDCT scan for assessment of LA and PV anatomy, LA thrombus evaluation, LA volume estimation, and electroanatomical mapping integration. Within a mean follow-up of 356 ± 128 days, 64% of the patients maintained sinus rhythm after the initial ablation, and 84% when including repeat PVA. LA diameter (P = 0.004), LA volume (P = 0.002), and type of AF (P = 0.001) were independent predictors of AF recurrence in univariate analysis. There was a relatively low correlation between the echocardiographic LA diameter and LA volume from MDCT (P = 0.01, r = 0.5). In multivariate analysis, paroxysmal AF (P < 0.006) and LA volume below the median value of 106 mL (P = 0.042) were significantly associated with the success of PVA, whereas LA diameter was not (P = 0.245). Analysing receiver-operator characteristics, the area under the curve for LA volume was 0.73 (P = 0.001) compared with 0.60 (P = 0.09) for LA diameter from echocardiography. CONCLUSION LA volume assessed by MDCT is a better predictor of AF recurrence after PVA than echocardiograpic LA diameter and can be derived from the pre-procedural imaging data set.
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Affiliation(s)
- Christian Sohns
- Department of Cardiology and Pneumology, Heart Center, Section Clinical Electrophysiology, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, Göttingen, Germany.
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Grubitzsch H, Haverkamp W. Atrial Remodelling : Role in Atrial Fibrillation Ablation. J Atr Fibrillation 2012; 5:691. [PMID: 28496795 DOI: 10.4022/jafib.691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/02/2012] [Accepted: 11/23/2012] [Indexed: 12/19/2022]
Abstract
There have been considerable advances in understanding the relationship of atrial fibrillation (AF) and atrial remodelling suggesting that remodelling states have a significant impact on treatment results. Therefore, we reviewed the literature about the role of atrial remodelling in AF treatment, focussing on AF ablation. Atrial fibrillatory activity, dominant frequencies (DF), complex fractionated atrial electrograms (CFAE) as well as function, volume, and fibrosis of the - especially left - atrium are most important characteristics for electrical, contractile, and structural remodelling predicting success of AF treatment. In particular, the results of AF ablation, either using catheter-based or surgical techniques, predominantly depend on the degree of structural remodelling, namely dilatation and fibrosis of the left atrium. The available data suggest that recognizing parameters of remodelling as predictors for AF treatment facilitates differentiation between patients who may or may not benefit from the procedure and individualization of AF treatment by adapting lesion sets, by ablating additional targets, by reducing left atrial size, or by applying extended pharmacological treatment.
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Affiliation(s)
| | - Wilhelm Haverkamp
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité - Universit?tsmedizin Berlin, Berlin, Germany
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Schmidt M, Straube F, Ebersberger U, Dorwarth U, Wankerl M, Krieg J, Hoffmann E. [Cardiac computed tomography and ablation of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2012; 23:281-288. [PMID: 23212602 DOI: 10.1007/s00399-012-0239-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/01/2012] [Indexed: 06/01/2023]
Abstract
Both cardiac computed tomography (CT) and interventional electrophysiology (EP) have evolved considerably in recent years. Technical improvements in CT have significantly reduced the radiation dose in cardiac applications. This imaging technology plays an important role in preprocedural planning and guidance of the procedures in many EP centers worldwide. Furthermore, CT is the imaging modality of choice to diagnose relevant complications in ablation of atrial fibrillation, e.g. pulmonary vein stenosis or atrioesophageal fistula. In anatomically driven ablation procedures, such as balloon-based procedures in atrial fibrillation, detailed analysis of the relevant cardiac structures is absolutely crucial not only to reduce radiation exposure and procedure times but also to improve ablation success and to reduce the occurrence of complications. Current software applications enable 3-dimensional reconstruction of cardiac images and the integration into electroanatomical navigation systems. This article reviews the available evidence in this field and highlights recent developments in image guidance for ablation of atrial fibrillation.
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Affiliation(s)
- Martin Schmidt
- Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum München-Bogenhausen, Englschalkingerstr. 77, 81925, München, Deutschland.
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Poor relationship between left atrial diameter and volume in patients with atrial fibrillation. COR ET VASA 2012. [DOI: 10.1016/j.crvasa.2012.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Use of preprocedural multidetector computed tomography to decrease atrial fibrillation recurrence following extensive encircling circumferential pulmonary vein isolation. J Cardiol 2012; 60:236-41. [DOI: 10.1016/j.jjcc.2012.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/15/2012] [Accepted: 03/28/2012] [Indexed: 11/20/2022]
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Akutsu Y, Tanno K, Kobayashi Y. The Role of Atrial Structural Remodeling in Atrial Fibrillation Ablation:An Imaging Point of View for Predicting Recurrence. J Atr Fibrillation 2012; 5:509. [PMID: 28496757 DOI: 10.4022/jafib.509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is associated with a significant morbidity and mortality. Invasive catheter ablation of AF has emerged as an effective therapy for patients with symptomatic AF. Atrial remodeling, particularly structural remodeling, is important not only for AF persistence but also for AF recurrence after ablation. Atrial dilation and fibrosis are two of the core processes involved in atrial structural remodeling. Increased automaticity and triggered activity occur in atrial structural remodeling, which may cause difficulty in maintaining sinus rhythm after ablation. Furthermore, an enlarged left atrium (LA) may increase the difficulty in achieving catheter stability and thereby require more energy to complete AF ablation. AF causes similar remodeling in both the left and right atria (RA), and myocardial changes in both atria influence AF recurrence. A non-invasive assessment of fibrotic structural remodeling helps predict the outcome of AF ablation. A varie ty of cardiac imaging modalities, such as two- or three-dimensional echocardiography or multi-detector row computed tomography, have been used to estimate the magnitude of atrial structural remodeling by measuring atrial volume or LA function. Furthermore, delayed enhanced cardiac magnetic resonance imaging has been used to detect not only atrial fibrosis but also the effect of the ablation point. Thus, atrial remodeling, particularly structural remodeling, plays an important role in AF recurrence. These non-invasive imaging modalities are significant tools for estimating atrial enlargement to improve patient selection for AF ablation at the point of paroxysmal AF, and for estimating atrial fibrosis to select the AF treatment including ablation strategy at the point of development to persistent or permanent AF.
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Affiliation(s)
- Yasushi Akutsu
- Division of Cardiology, Department of Medicine Showa University School of Medicine, Tokyo, Japan
| | - Kaoru Tanno
- Division of Cardiology, Department of Medicine Showa University School of Medicine, Tokyo, Japan
| | - Youichi Kobayashi
- Division of Cardiology, Department of Medicine Showa University School of Medicine, Tokyo, Japan
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PARK YAEM, CHOI JONGIL, LIM HONGE, PARK SANGW, KIM YOUNGHOON. Is Pursuit of Termination of Atrial Fibrillation During Catheter Ablation of Great Value in Patients with Longstanding Persistent Atrial Fibrillation? J Cardiovasc Electrophysiol 2012; 23:1051-8. [DOI: 10.1111/j.1540-8167.2012.02370.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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