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Leung M, van Rosendael PJ, van der Bijl P, Regeer MV, van Wijngaarden SE, Leung DY, Delgado V, Marsan NA, Ng ACT, Bax JJ. The value of serial echocardiography in risk assessment of patients with paroxysmal atrial fibrillation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:499-508. [PMID: 38148375 DOI: 10.1007/s10554-023-03014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023]
Abstract
Progression from paroxysmal to persistent atrial fibrillation (AF) is associated with increased morbidity and mortality. We examined the association of left atrial (LA) remodeling by serial echocardiography, and AF progression over an extended follow-up period. Two-hundred ninety patients (mean age 61 ± 11 years, 73% male) who underwent transthoracic echocardiography performed at first presentation for non-valvular paroxysmal AF (PAF) and repeat echocardiogram 1-year later, were followed for progression to persistent AF. LA and left ventricular (LV) dimensions, volumes, LA reservoir, conduit and booster pump strains, LV global longitudinal systolic strain (GLS) assessed by 2D speckle tracking, and PA-TDI (time delay between electrical and mechanical LA activation- reflecting the extent of LA fibrosis) were compared on serial echocardiography. Sixty-nine (24%) patients developed persistent AF over a mean follow-up period of 6.3 years. At baseline, patients with subsequent persistent AF had larger LA dimensions (46 mm vs. 42 mm, p < 0.001), indexed LA volumes (41 ml/m2 vs. 34 ml/m2, p < 0.001), lower LA reservoir and conduit strain (17.6% vs. 27.6%, p < 0.001; 10.5% vs. 16.3%, p < 0.001; respectively) and longer PA-TDI (155 ms vs. 132 ms, p < 0.001) compared to the PAF group. Patients with subsequent persistent AF showed over time significant enlargement in LA volumes (from 37.7 ml/m2 to 42.4 ml/m2, p < 0.001), lengthening of PA-TDI (from 142.2 ms to 162.2 ms, p = 0.002), and decline in LA reservoir function (from 21.9% to 18.1%, p = 0.024) after adjusting for age, gender, diabetes and LV GLS. There were no changes in LA diameter, LA conduit or booster pump function. Conversely, the PAF group showed no decline in LA function. Patients who developed persistent AF had larger LA size and impaired LA function and atrial conduction times at baseline, compared to patients who remained PAF. Over the 1-year time course of serial echocardiographic evaluation, there was progression of LA remodeling in patients who subsequently developed persistent AF, but not in patients who remained in PAF.
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Affiliation(s)
- Melissa Leung
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
- Department of Cardiology, Liverpool Hospital, Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia.
| | | | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Madelien V Regeer
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Dominic Y Leung
- Department of Cardiology, Liverpool Hospital, Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Arnold C T Ng
- The University of New South Wales, Sydney, Australia
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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Yates TA, Vijayakumar R, McGilvray M, Khiabani AJ, Razo N, Sinn L, Schill MR, Marrouche N, Zemlin C, Damiano RJ. Delayed-enhancement cardiac magnetic resonance imaging detects disease progression in patients with mitral valve disease and atrial fibrillation. JTCVS OPEN 2023; 16:292-302. [PMID: 38204711 PMCID: PMC10774962 DOI: 10.1016/j.xjon.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 01/12/2024]
Abstract
Objectives The mechanism by which mitral valve (MV) disease leads to atrial fibrillation (AF) remains poorly understood. Delayed-enhancement cardiac magnetic resonance imaging (DE-MRI) has been used to assess left atrial (LA) fibrosis in patients with lone AF before catheter ablation; however, few studies have used DE-MRI to assess MV-induced LA fibrosis in patients with or without AF undergoing MV surgery. Methods Between March 2018 and September 2022, 38 subjects were enrolled; 15 age-matched controls, 14 patients with lone mitral regurgitation (MR), and 9 patients with MR and AF (MR + AF). Indexed LA volume, total LA wall, and regional LA posterior wall (LAPW) enhancement were defined by the DE-MRI. One-way analysis of variance was performed. Results LA volume and LA enhancement were associated (r = 0.451, P = .004). LA volume differed significantly between controls (37.1 ± 10.6 mL) and patients with lone MR (71.0 ± 35.9, P = .020 and controls and patients with MR + AF (99.3 ± 47.4, P < .001). The difference in LA enhancement was significant between MR + AF (16.7 ± 9.6%) versus controls (8.3 ± 3.9%, P = .006) and MR + AF versus lone MR (8.0 ± 4.8%, P = .004). Similarly, the was significantly more LAPW enhancement in the MR + AF (17.5 ± 8.7%) versus control (9.2 ± 5.1%, P = .011) and MR + AF versus lone MR (9.8 ± 6.0%, P = .020). Conclusions Patients with MR + AF had significantly more total and LAPW fibrosis compared with both controls and lone MR. Volume and delayed enhancement were associated, but there was no difference between MR and MR + AF.
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Affiliation(s)
- Tari-Ann Yates
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Ramya Vijayakumar
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Martha McGilvray
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Ali J. Khiabani
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Nicholas Razo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Laurie Sinn
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Matthew R. Schill
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Nassir Marrouche
- Department of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Christian Zemlin
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
| | - Ralph J. Damiano
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, Mo
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Kim J, Park SJ, Jeong DS, Chung S, Jeon K, Bak M, Kim D, Kim EK, Chang SA, Lee SC, Park SW. Left atrial strain predicts fibrosis of left atrial appendage in patients with atrial fibrillation undergoing totally thoracoscopic ablation. Front Cardiovasc Med 2023; 10:1130372. [PMID: 37265565 PMCID: PMC10229857 DOI: 10.3389/fcvm.2023.1130372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Abstract
Background Left atrial (LA) fibrosis is related with development and severity of atrial fibrillation (AF). The aim of this study was to investigate the association between LA strain and LA fibrosis in patients undergoing totally thoracoscopic ablation (TTA) for AF. Methods Between February 2012 and March 2015, a total of 128 patients who underwent TTA were enrolled from a tertiary hospital. Left atrial appendage (LAA) was harvested during surgery to determine the degree of fibrosis. LAA fibrosis was classified as mild (1st quartile), moderate (2nd and 3rd quartile), or severe (4th quartile). Clinical outcome was 5-year recurrence rate of AF detected on electrocardiogram or 24 h Holter monitoring. Results The mean age was 54.3 ± 8.8 years and 18.8% had paroxysmal AF. Patients with mild LAA fibrosis had a significantly lower rate of recurrent AF (23.3%) at 5 years after TTA compared with those with moderate (51.4%; hazard ratio [HR] 2.69; 95% confidence interval [CI] 1.19-6.12) or severe (53.2%; HR 2.84; 95% CI 1.16-6.97) fibrosis. Among clinical and echocardiographic parameters, peak LA strain was the only predictor of mild LAA fibrosis (coefficient 0.10, p = 0.005) with the best cutoff value of 14.7% (area under the curve 0.732). The prevalence of mild LAA fibrosis was 40.6% in patients with peak LA strain ≥14.7%, but only 6.8% in those with peak LA strain <14.7%. Conclusions In patients undergoing TTA for AF, mild LAA fibrosis was associated with a lower risk of 5-year AF recurrence. LA strain was the only predictor of mild LAA fibrosis that reflects a lower risk of 5-year AF recurrence.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Seop Jeong
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kina Jeon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Minjung Bak
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Hopman LHGA, Visch JE, Bhagirath P, van der Laan AM, Mulder MJ, Razeghi O, Kemme MJB, Niederer SA, Allaart CP, Götte MJW. Right atrial function and fibrosis in relation to successful atrial fibrillation ablation. Eur Heart J Cardiovasc Imaging 2022; 24:336-345. [PMID: 35921538 PMCID: PMC9936834 DOI: 10.1093/ehjci/jeac152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Bi-atrial remodelling in patients with atrial fibrillation (AF) is rarely assessed and data on the presence of right atrial (RA) fibrosis, the relationship between RA and left atrial (LA) fibrosis, and possible association of RA remodelling with AF recurrence after ablation in patients with AF is limited. METHODS AND RESULTS A total of 110 patients with AF undergoing initial pulmonary vein isolation (PVI) were included in the present study. All patients were in sinus rhythm during cardiac magnetic resonance (CMR) imaging performed prior to ablation. LA and RA volumes and function (volumetric and feature tracking strain) were derived from cine CMR images. The extent of LA and RA fibrosis was assessed from 3D late gadolinium enhancement images. AF recurrence was followed up for 12 months after PVI using either 12-lead electrocardiograms or Holter monitoring. Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (interquartile range: 122-286) days. RA remodelling parameters were not significantly different between patients with and without AF recurrence after ablation, whereas LA remodelling parameters were different (volume, emptying fraction, and strain indices). LA fibrosis had a strong correlation with RA fibrosis (r = 0.88, P < 0.001). Both LA and RA fibrosis were not different between patients with and without AF recurrence. CONCLUSIONS This study shows that RA remodelling parameters were not predictive of AF recurrence after AF ablation. Bi-atrial fibrotic remodelling is present in patients with AF and moreover, the amount of LA fibrosis had a strong correlation with the amount of RA fibrosis.
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Affiliation(s)
| | - Julia E Visch
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Orod Razeghi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | | | - Steven A Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | | | - Marco J W Götte
- Corresponding author. Tel: +31 20 444 0123; Fax: +31 20 4442446. E-mail:
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Regional Diversities in Fibrogenesis Weighed as a Key Determinant for Atrial Arrhythmogenesis. Biomedicines 2021; 9:biomedicines9121900. [PMID: 34944715 PMCID: PMC8698388 DOI: 10.3390/biomedicines9121900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022] Open
Abstract
Atrial fibrosis plays a key role in atrial myopathy, resulting in the genesis of atrial fibrillation (AF). The abnormal distribution of fibrotic tissue, electrical coupling, paracrine interactions, and biomechanical–electrical interactions have all been suggested as causes of fibrosis-related arrhythmogenesis. Moreover, the regional difference in fibrogenesis, specifically the left atrium (LA) exhibiting a higher arrhythmogenesis and level of fibrosis than the right atrium (RA) in AF, is a key contributor to atrial arrhythmogenesis. LA fibroblasts have greater profibrotic cellular activities than RA fibroblasts, but knowledge about the regional diversity of atrial regional fibrogenesis remains limited. This article provides a comprehensive review of research findings on the association between fibrogenesis and arrhythmogenesis from laboratory to clinical evidence and updates the current understanding of the potential mechanism underlying the difference in fibrogenesis between the LA and RA.
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Grassinger JM, Henrich M, Echevarría AC, März I, Henrich E, Bartel A, Schneider M, Aupperle-Lellbach H. Correlation of Histopathological Changes in the Left Atrium and Left Atrial Appendage with the Degree of Dilation in Cats. J Comp Pathol 2021; 189:8-25. [PMID: 34886990 DOI: 10.1016/j.jcpa.2021.09.001] [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: 12/30/2020] [Revised: 04/12/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
Although atrial dilation is a common finding in feline cardiac disease, detailed investigations of atrial pathology are rare in cats. The aim of the study was to investigate the correlation between pathohistological findings, morphometric data and the degree of dilation of the left atrial appendage (LAA) in 53 cats. Based on the LAA volume, the samples were grouped into normal/control (group 0, ≤1 ml [n = 9]), mildly dilated (group 1, >1 to ≤2 ml [n = 16]), moderately dilated (group 2, >2 to ≤3 ml [n = 14]) and markedly dilated (group 3, >3 ml [n = 14]) groups, independent of the underlying disease. Samples from the LAA and the left atrium (LA) were histologically evaluated using haematoxylin and eosin- and Picrosirius red-stained sections, and morphometrically analysed using an image analysis system. The degree of endo-, myo- and epicardial fibrosis was directly correlated with increased LAA dilation. Due to cardiomyocyte hyperplasia and hypertrophy, the mean thickness of the atrial wall was significantly greater in groups 1 and 2 than in group 0. Conversely, group 3 had a lower mean atrial wall thickness than groups 1 and 2, which was attributed to increased transmural fibrosis and cardiomyocyte atrophy. These findings reflect intensive dynamic remodelling processes during LA and LAA dilation, indicating that reversibility appears to be limited in cases of severe left atrial dilation.
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Affiliation(s)
- Julia M Grassinger
- LABOKLIN GmbH & Co. KG, Labor für Klinische Diagnostik, Bad Kissingen, Berlin, Germany.
| | - Manfred Henrich
- Institut für Veterinär-Pathologie, Veterinärmedizinische Fakultät der Justus-Liebig-Universität Gießen, Gießen, Berlin, Germany
| | - Argine C Echevarría
- LABOKLIN GmbH & Co. KG, Labor für Klinische Diagnostik, Bad Kissingen, Berlin, Germany
| | - Imke März
- Tierklinik Hofheim, Hofheim, Berlin, Germany
| | - Estelle Henrich
- Klinik für Kleintiere, Veterinärmedizinische Fakultät der Justus-Liebig-Universität Gießen, Gießen, Berlin, Germany
| | - Alexander Bartel
- Institut für Veterinär-Epidemiologie und Biometrie, Freie Universität Berlin, Berlin, Germany
| | - Matthias Schneider
- Klinik für Kleintiere, Veterinärmedizinische Fakultät der Justus-Liebig-Universität Gießen, Gießen, Berlin, Germany
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7
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Prominent atrial fibrosis and its correlation with dilated atrium atrial tachyarrhythmia and long after classic Fontan surgery. J Cardiol 2021; 79:671-677. [DOI: 10.1016/j.jjcc.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022]
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Impact of maze procedure in patients with severe tricuspid regurgitation and persistent atrial fibrillation. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01535-X. [PMID: 34872766 DOI: 10.1016/j.jtcvs.2021.10.057] [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: 05/25/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with severe tricuspid regurgitation and persistent atrial fibrillation may not be good candidates for maze procedure due to preoperative atrial remodeling and various comorbidities. We attempted to evaluate the rhythm and clinical outcomes of maze procedure in these patients. METHODS Patients with severe tricuspid regurgitation and persistent atrial fibrillation who underwent tricuspid valve surgery between January 1994 and December 2017 at a single tertiary center were analyzed. The primary end point was sinus rhythm restoration. The key secondary end point was major adverse cardiovascular and cerebrovascular event rate, which is the composite event of stroke, cardiac death, major bleeding, and readmission for heart failure. Propensity score matching analysis was used. RESULTS A total of 388 patients underwent tricuspid valve surgery, and among them 172 patients (44%) underwent concomitant maze procedure. The maze group had sinus rhythm restoration rate of 56% in 9 years. Further, in the matched cohort, the maze group had higher freedom from major adverse cardiovascular and cerebrovascular event rate at 10 years than the nonmaze group (55.6% vs 36.2%; P = .047). Preoperative left atrial diameter (hazard ratio, 1.022; 95% CI, 1.012-1.033; P < .001) and right atrial diameter (hazard ratio, 1.012; 95% CI, 1.003-1.022; P = .013) were independent risk factors for failure of sinus rhythm. CONCLUSIONS Maze procedure in severe tricuspid regurgitation and persistent atrial fibrillation had acceptable rates of sinus rhythm restoration and reduced major adverse cardiovascular and cerebrovascular events in the long-term. Careful patient selection considering preoperative atrial diameters is needed to enhance maze success rate and long-term clinical outcomes.
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Gong S, Zhou J, Li B, Kang S, Ma X, Cai Y, Guo Y, Hu R, Zhang X. The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation. Front Cardiovasc Med 2021; 8:677885. [PMID: 34458330 PMCID: PMC8387723 DOI: 10.3389/fcvm.2021.677885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: The probability of late recurrent atrial fibrillation (AF) after radiofrequency ablation (RFA) has not yet been fully clarified. This study aims to study the association of left atrial appendage (LAA) morphology with AF recurrence after RFA. Methods: We retrospectively enrolled 84 patients (24 patients had persistent AF, 60 patients had paroxysmal AF) who underwent RFA in Shanghai East Hospital from June 2014 to May 2018. The mean follow-up of these patients was 618.6 days. According to preoperative transesophageal echocardiography (TEE), the morphology feature of LAA was classified and evaluated by two classification methods. The first method was divided into chicken-wing, windsock, cactus, and cauliflower, and the second method was divided into one lobe, two lobes, and multiple lobes. The correlation between morphological feature of LAA and the recurrence rate of AF after RFA was analyzed. Results: During follow-up, 12 patients (50%) and 10 patients (16.7%) had AF recurrence in persistent and paroxysmal AF, respectively. The LAA morphology was associated with the recurrence of AF after RFA with the chicken-wing highest recurrence risk (68.2%). The structure type of LAA was also related to the AF recurrence rate (p < 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p < 0.02). Logistic regression analysis showed that the chicken-wing group had a higher risk of recurrence after RFA (OR = 8.13, p = 0.004), and the windsock group had a lower risk of recurrence (OR = 0.17, p = 0.002). Conclusion: The morphological feature of LAA is related to the recurrence risk of AF after RFA. LAA morphology assessment can predict the risk of AF recurrence.
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Affiliation(s)
- Shiyu Gong
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhou
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Sheng Kang
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoye Ma
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Cai
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yang Guo
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rui Hu
- Department of Laboratory, Taiyuan Hospital Health Center for Woman and Children, Taiyuan, China
| | - Xumin Zhang
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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Chen J, Wang Y, Lv M, Yang Z, Zhu S, Wei L, Hong T, Ding W, Lin Y, Wang C. Mitral valve repair and surgical ablation for atrial functional mitral regurgitation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1420. [PMID: 33313165 PMCID: PMC7723636 DOI: 10.21037/atm-20-2958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background This observational study aimed to share our experience in the surgical management of atrial functional mitral regurgitation (AFMR). Methods We retrospectively identified 82 AFMR patients (63.6±7.7 years) from June 2008 to November 2018 at our institution. Of these patients, 72.0% of them were classified as NYHA functional class III/IV, and all of them had persistent AF. All patients underwent mitral valve (MV) repair, and 52 (63.4%) received concomitant surgical ablation (SA). Patients were followed up for 26.1±27.6 months, and postoperative mitral regurgitation (MR) was assessed by echocardiography. Results There was no in-hospital mortality. The overall 1-year and 3-year survival rates were 97.5% and 92.9%, respectively, and 96.1% of patients recovered to NYHA functional class I/II at the latest follow-up. The left atrium (LA) diameter (P<0.001), left ventricular (LV) end-diastolic diameter (P<0.001), LV end-systolic diameter (LVESD) (P<0.001) and pulmonary artery pressure (P=0.006) significantly decreased postoperatively. The overall 1-year and 3-year freedom from recurrent MR rates were 94.3% and 65.3%, respectively, and a significant difference was found between the SA group and the non-SA group (93.8% and 93.8% vs. 95.5% and 44.2%, P=0.035). In a subgroup analysis, this significant difference was only found in the small LA group (≤60 mm). Conclusions Our results suggest that MV repair for AFMR is safe and effective. It improves heart failure symptoms and results in reverse-remodeling of both the LA and LV. Concomitant SA might benefit patients in terms of recurrent MR, especially in the small LA group (≤60 mm).
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Affiliation(s)
- Jinmiao Chen
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yulin Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaohua Yang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shijie Zhu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Hong
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjun Ding
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Lin
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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11
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Zhang D, Li B, Li B, Tang Y. Regulation of left atrial fibrosis induced by mitral regurgitation by SIRT1. Sci Rep 2020; 10:7278. [PMID: 32350389 PMCID: PMC7190846 DOI: 10.1038/s41598-020-64308-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/10/2020] [Indexed: 11/09/2022] Open
Abstract
SIRT1 (silent information regulator 1) is a histone deacetylase. It can sense the energy level in cells and delay cell senescence, leading to resistance to external stress and improving metabolism. Mitral regurgitation (MR) is a common disease in cardiac surgery. However, there are no previous studies on SIRT1 and left atrial fibrosis caused by MR. In this study, we aimed to explore the regulatory effect of SIRT1 on left atrial fibrosis induced by MR. We used Guizhou miniature pigs to establish an MR model and a sham operation model after anaesthesia induction and respiratory intubation, and these model animals were followed for 30 months after the surgery. The differential distribution and expression of SIRT1 and collagen I in the left atrium was determined by immunofluorescence and Western blotting. Furthermore, we treated NIH3T3 fibroblasts (CFs) with resveratrol and Angiotensin II (Ang II) to analyse the specific mechanism involved in the development of myocardial fibrosis. The results showed that the MR model was successfully constructed. There were 8 pigs in the MR group and 6 pigs in the control group. In both the animal experiments and the cell experiments, the expression of collagen I in the MR group was increased significantly compared to that in the control group, while the expression of SIRT1 was decreased.
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Affiliation(s)
- Dong Zhang
- Beijing Jishuitan Hospital, Department of Thoracic Surgery, Beijing, China
| | - Bo Li
- The Seventh Affiliated Hospital, Sun Yat-sen University, Department of Cardiac Surgery, Shenzhen, China
| | - Bin Li
- Animal Experimental Centre, Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Tang
- Animal Experimental Centre, Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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12
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Li B, Luo F, Luo X, Li B, Qi L, Zhang D, Tang Y. Effects of atrial fibrosis induced by mitral regurgitation on atrial electrophysiology and susceptibility to atrial fibrillation in pigs. Cardiovasc Pathol 2019; 40:32-40. [DOI: 10.1016/j.carpath.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 01/28/2023] Open
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13
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Leung M, Abou R, van Rosendael PJ, van der Bijl P, van Wijngaarden SE, Regeer MV, Podlesnikar T, Ajmone Marsan N, Leung DY, Delgado V, Bax JJ. Relation of Echocardiographic Markers of Left Atrial Fibrosis to Atrial Fibrillation Burden. Am J Cardiol 2018; 122:584-591. [PMID: 30049466 DOI: 10.1016/j.amjcard.2018.04.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/22/2018] [Accepted: 04/25/2018] [Indexed: 12/12/2022]
Abstract
In patients with atrial fibrillation (AF), left atrial (LA) fibrosis is a major determinant of the progression to, and burden of AF. LA reservoir strain and total atrial conduction time (PA-TDI) reflect LA fibrotic content. We aimed to investigate the relation between LA reservoir strain and PA-TDI in AF patients and control subjects. Six-hundred two patients (mean age 56 years, 53% men) with first episode of AF and 342 controls (mean age 64 years, 71% men) without structural heart disease underwent echocardiography. LA volumes, PA-TDI, LA reservoir strain, and left ventricular global longitudinal strain (GLS) were compared. Compared with controls, patients with paroxysmal AF and patients with persistent AF had longer PA-TDI (128 ± 25 millisecond, 140 ± 31 millisecond, and 154 ± 33 millisecond, respectively; p <0.001) and a progressive decline in LA reservoir strain (36.9 ± 11.6%, 29.8 ± 13.4%, 24.2 ± 12.3%, respectively; p <0.001). LA reservoir strain was negatively correlated with PA-TDI (r = -0.43, p <0.001). On multivariate analyses, LA reservoir strain, diabetes mellitus, and burden of AF were independent correlates of PA-TDI (R2 = 0.23, p <0.001); whereas only PA-TDI was an independent correlate of LA reservoir strain (R2 = 0.43, p <0.001); controlling for age, hypertension, coronary artery disease, body mass index, severity of mitral regurgitation, left ventricular global longitudinal strain, and LA volume. In conclusion, PA-TDI and LA reservoir strain are negatively correlated in all subjects, irrespective of the presence or burden of AF. Patients with persistent AF have longer PA-TDI and impaired LA reservoir strain compared with paroxysmal AF and controls, suggesting increasing burden of fibrosis and LA structural remodeling in the progression of AF.
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Nery PB, Al Dawood W, Nair GM, Redpath CJ, Sadek MM, Chen L, Green MS, Wells G, Birnie DH. Characterization of Low-Voltage Areas in Patients With Atrial Fibrillation: Insights From High-Density Intracardiac Mapping. Can J Cardiol 2018; 34:1033-1040. [PMID: 30056843 DOI: 10.1016/j.cjca.2018.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/21/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND There is limited data on the scar burden in patients with atrial fibrillation (AF). In this study, we sought to evaluate the presence and extent of an abnormal left atrial (LA) substrate in patients with paroxysmal or persistent AF. METHODS Consecutive patients who underwent initial AF catheter ablation were prospectively enrolled. Endocardial voltage mapping was acquired in sinus rhythm using multipolar mapping catheters. Automated software was used to ensure homogeneous data collection. Assessment of low-voltage area (LVA) was performed by a reviewer blinded to clinical details. RESULTS One hundred and four patients were prospectively enrolled; 69 had paroxysmal and 35 persistent AF. The mean LA volume was 159 ± 48 mL, and the average number of LA points collected was 1308 ± 1065. Atrial LVAs were present in 23 of 69 (33%) subjects with paroxysmal and 20 of 35 (57%) with persistent AF (P = 0.02). Amongst 43 of 104 patients with scar, the average extent of LVA was 19.4 ± 21.6 cm2 and the mean percentage area was 7.6 ± 8.8%. Univariate analysis showed that age, LA volume, and persistent AF were associated with the presence of LVA. Multivariable analysis showed that age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.00-1.11; P = 0.046) and LA volume (OR 1.02; 95% CI 1.01-1.04; P < 0.001) remained predictors of LVA. AF classification (persistent vs paroxysmal) was not a predictor of an abnormal atrial substrate (OR 1.34; 95% CI 0.4-3.9; P = 0.56). CONCLUSIONS There is wide variability in the presence and extent of LVA in patients with paroxysmal or persistent AF. Age and LA volume were predictors of LVA. There was no correlation between AF classification and the presence of LVA.
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Affiliation(s)
- Pablo B Nery
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Wafa Al Dawood
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish M Nair
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Calum J Redpath
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mouhannad M Sadek
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Li Chen
- Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Martin S Green
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Wells
- Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David H Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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15
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Galjautdinov1 GS, Gorelkin IV, Ibragimova KR, Sadriev RR. NEW-ONSET ATRIAL FIBRILLATION IN SETTINGS OF ACUTE CORONARY SYNDROME. CURRENT ISSUES. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-3-451-457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present review is focuses on new onset atrial fibrillation (AF) in conditions of acute coronary syndrome (ACS). Literature sources from PubMed and Scopus was used. AF is common in the general population and in the ACS population, at that new onset AF, and AF, which was by the time of ACS development are determined. Appearance of AF is more likely amongst the elderly patients with congestive heart failure, with signs of the hemodynamic instability and with the left atrium dilatation. It is well-known about the predictors of adverse outcome in ACS. According to some literature data new onset AF leads to worsening of prognosis, and in line with other sources a reason of its association with high level of mortality is due to the severity of ACS and appearance of AF is not independent predictor of death. The absence of subjective symptoms at the time of paroxysm of new onset AF does not allow estimating its duration and distinguishing between the new onset AF, persistent and constant AF. It is possible to trace the relationship between the myocardial ischemia and AF appearance. Inefficient reperfusion during percutaneous coronary intervention or thrombolytic therapy is accompanied by the onset of AF, on the contrary, when effective patency of coronary artery is achieved, AF appears significantly less often. New onset AF in ACS, in particular, accompanied by cardiogenic shock, requires emergency pharmacological or electrical cardioversion. In some cases, active cardioversion is not necessary, because of spontaneous cardiac rhythm conversion. In conclusions, it is necessary to point out, that ambiguity and multifactority of this problem demands investigation of arrhythmogenesis mechanisms and development of special risk stratification instruments for the new onset AF in ACS.
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16
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Klein O, Hanke T, Nebrich G, Yan J, Schubert B, Giavalisco P, Noack F, Thiele H, Mohamed SA. Imaging Mass Spectrometry for Characterization of Atrial Fibrillation Subtypes. Proteomics Clin Appl 2018; 12:e1700155. [DOI: 10.1002/prca.201700155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Oliver Klein
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and; Berlin Institute of Health Berlin-Brandenburg Center for Regenerative Therapies; 13353 Berlin Germany
| | - Thorsten Hanke
- Department of Cardiac and Thoracic Vascular Surgery; University of Luebeck; 23538 Luebeck Germany
| | - Grit Nebrich
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and; Berlin Institute of Health Berlin-Brandenburg Center for Regenerative Therapies; 13353 Berlin Germany
| | - Junfeng Yan
- Department of Cardiac and Thoracic Vascular Surgery; University of Luebeck; 23538 Luebeck Germany
| | - Benedikt Schubert
- Department of Cardiac and Thoracic Vascular Surgery; University of Luebeck; 23538 Luebeck Germany
| | - Patrick Giavalisco
- Experimental Systems Biology; Max Planck Institute of Molecular Plant Physiology; 14476 Golm Germany
| | - Frank Noack
- Institute of Pathology; Martin-Luther Hospital; 14193 Berlin Germany
| | - Herbert Thiele
- Fraunhofer Institute for Medical Image Computing MEVIS; 23538 Luebeck Germany
| | - Salah A. Mohamed
- Department of Cardiac and Thoracic Vascular Surgery; University of Luebeck; 23538 Luebeck Germany
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17
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Kimata A, Yokoyama Y, Aita S, Nakamura H, Higuchi K, Tanaka Y, Nogami A, Hirao K, Aonuma K. Temporally stable frequency mapping using continuous wavelet transform analysis in patients with persistent atrial fibrillation. J Cardiovasc Electrophysiol 2018; 29:514-522. [PMID: 29369468 DOI: 10.1111/jce.13440] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dominant frequency (DF) derived from fast Fourier transform (FFT) analysis has failed to guide atrial fibrillation (AF) ablation since it cannot guarantee temporal stability. Continuous wavelet transform (CWT) analysis is another frequency analysis that can show the temporal stability of a frequency. METHODS AND RESULTS Forty-four consecutive patients with persistent AF (PeAF) underwent pulmonary vein (PV) isolation (PVI) as the first-time catheter ablation. The PVs and left atrium were mapped and electrograms (EGMs) were recorded for 30 seconds at each site. Pseudo-frequency (PF) and coefficient of variation (CV) were calculated by CWT analysis. A PF with CV ≤ 10 was defined as a temporally stable PF (sPF). DF was also calculated by traditional FFT analysis from the first 5 seconds of the recorded EGMs. The highest sPF was shown inside the PVs in 20 patients (PV group), and at the non-PV sites in 24 patients (non-PV group). During the follow-up period of 15.3 ± 4.4 months, the ablation success rate in the PV group was significantly higher than that in the non-PV group (90% vs. 62%, P = 0.023). The location of the highest DF did not have a significant effect on ablation success rate between inside the PVs and at the non-PV sites. CONCLUSION PVI results for PeAF were significantly worse for patients with highest sPF at the non-PV sites compared to patients with highest sPF sites inside the PVs. CWT analysis during AF could be used to verify whether PVI alone is sufficient for the first-time catheter ablation in patients with PeAF.
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Affiliation(s)
- Akira Kimata
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasuhiro Yokoyama
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Satoshi Aita
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroaki Nakamura
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Koji Higuchi
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Yasuaki Tanaka
- Department of Cardiology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kenzo Hirao
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Yang B, Jiang C, Lin Y, Yang G, Chu H, Cai H, Lu F, Zhan X, Xu J, Wang X, Ching CK, Singh B, Kim YH, Chen M. STABLE-SR (Electrophysiological Substrate Ablation in the Left Atrium During Sinus Rhythm) for the Treatment of Nonparoxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005405. [PMID: 29141843 DOI: 10.1161/circep.117.005405] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Bing Yang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Chenyang Jiang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Yazhou Lin
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Gang Yang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Huimin Chu
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Heng Cai
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Fengmin Lu
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Xianzhang Zhan
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Jian Xu
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Xinhua Wang
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Chi-Keong Ching
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Balbir Singh
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Young-Hoon Kim
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
| | - Minglong Chen
- From the Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (B.Y., G.Y., M.C.); Department of Cardiology Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.J.); Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (Y.L.); Department of Cardiology, Ningbo First Hospital, Zhejiang University, Ningbo, China (H. Chu); Department of Cardiology, General Hospital, Tianjin Medical University, China (H. Cai)
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Chen M. Scar homogenization in AF ablation: Evolution and practice. J Atr Fibrillation 2017; 10:1618. [PMID: 29250226 PMCID: PMC5673332 DOI: 10.4022/jafib.1618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/10/2022]
Abstract
Laboratory studies, histology studies, image studies and the clinical studies all prove the positive correlation between atrial fibrillation and atrial fibrosis from different perspectives. Atrial fibrosis, by separating myocardial cell coupling, diminishing conduction velocity and promoting anisotropic conduction, produce the substrate to sustain atrial fibrillation (AF). These fibrotic areas can be translated into signal abnormalities (low voltage and complex electrgram), and be depicted by electroanatomic high density map. Ablation targeting these areas after circumferential pulmonary vein produces isolation as the additional substrate modification strategy has proved its beneficial results. However, the unified methodology regarding the scar definition, the mapping rhythm (AF or sinus rhythm) and the modification endpoint is yet to be negotiated. Large-scale clinical trials, long-term follow-up results are needed to prove its contribution to the overall success rate of AF ablation.
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Affiliation(s)
- Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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20
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Li Z, Wang Z, Yin Z, Zhang Y, Xue X, Han J, Zhu Y, Zhang J, Emmert MY, Wang H. Gender differences in fibrosis remodeling in patients with long-standing persistent atrial fibrillation. Oncotarget 2017; 8:53714-53729. [PMID: 28881845 PMCID: PMC5581144 DOI: 10.18632/oncotarget.16342] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/06/2017] [Indexed: 01/30/2023] Open
Abstract
The success rate of catheter ablation in atrial fibrillation (AF) is known to be lower in females than in males. However, while the exact mechanism for this phenomenon remains to be elucidated, tissue fibrosis may play an important role in this regard. It has been shown that fibrosis promotes AF and its recurrence, thereby substantially reducing the efficacy of catheter ablation in AF patients. Thus, we hypothesized that fibrosis may contribute to gender differences in the outcomes of AF catheter ablation. Here we systematically assessed pulmonary vein sleeves obtained from 166 patients with and without long-standing persistent-AF (LSP-AF) in order to identify gender-specific mechanistic differences in fibrosis remodeling of AF patients. Histological analysis revealed that the female LSP-AF group, rather than its male counterpart, had a higher degree of fibrosis when compared to the NON-AF group. Further analysis using microarray, immunohistochemistry and Western Blot displayed that gender differences in fibrosis remodeling of LSP-AF were mainly due to the inherent differential expression of fibrosis-related genes (n=32) and proteins (n=6). Especially, those related to the TGFβ/Smad3 pathway appeared to be up-regulated in the female LSP-AF group thus promoting an aggravation of fibrosis remodeling. In summary, our data suggest that the aggravation of fibrosis remodeling in women may be an important reason for the low success rate of AF catheter ablation when compared to men. Therefore, inhibiting the TGFβ/Smad3 pathway-mediated fibrosis could represent an interesting target for future therapeutic concepts to improve the success rate of AF catheter ablation in women.
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Affiliation(s)
- Zhi Li
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Zengwei Wang
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Zongtao Yin
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Yuji Zhang
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Xiaodong Xue
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Jinsong Han
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Yan Zhu
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Jian Zhang
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
| | - Maximilian Y Emmert
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Rämistrasse, Zürich, Switzerland
| | - Huishan Wang
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
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Begg GA, Karim R, Oesterlein T, Graham LN, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. Intra-cardiac and peripheral levels of biochemical markers of fibrosis in patients undergoing catheter ablation for atrial fibrillation. Europace 2017; 19:1944-1950. [DOI: 10.1093/europace/euw315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/10/2016] [Indexed: 12/13/2022] Open
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22
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Atrial tissue expression of receptor for advanced glycation end-products (RAGE) and atrial fibrosis in patients with mitral valve disease. Int J Cardiol 2016; 220:1-6. [DOI: 10.1016/j.ijcard.2016.06.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/18/2016] [Accepted: 06/23/2016] [Indexed: 12/28/2022]
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23
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Foglieni C, Rusconi R, Mantione ME, Fragasso G, Alfieri O, Maisano F. Early left atrial tissue features in patients with chronic mitral regurgitation and sinus rhythm: Alterations of not remodeled left atria. Int J Cardiol 2016; 219:433-8. [PMID: 27372606 DOI: 10.1016/j.ijcard.2016.06.047] [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] [Received: 05/03/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Left atrial (LA) enlargement, a compensatory mechanism in chronic mitral regurgitation (MR) increasing the risk of atrial fibrillation (AF) and predictive of cardiac events, involves structural alterations. We characterized LA features in patients in sinus rhythm with severe degree of MR, similar degrees of left ventricular remodeling but divergent LA size. METHODS Among a consecutive series of 163 patients in stable sinus rhythm undergoing isolated mitral valve surgery for severe non-rheumatic MR, two groups were arbitrarily selected according to their LA size (antero-posterior): NRLA group (non-remodeled LA) included 8 patients with LA≤40mm, RLA group (remodeled LA) included 8 patients with LA>55mm. LA biopsies were processed for paraffin inclusion and sectioning. Fibrosis, cardiomyocytes morphology, capillaries density, cytochrome c and F-actin expression were evaluated by microscopy. RESULTS Histology and immunohistochemistry demonstrated alteration of moderate entity: higher amounts of endomysial fibrosis (not of collagen type III) and of hypertrophic cardiomyocytes in RLA than in NRLA. Confocal microscopy displayed focally disorganized F-actin and no nuclear fragmentation in both groups, but more intra-cytoplasm cytochrome c in RLA vs. NRLA, possibly indicative of more successful escape to apoptosis by NRLA cardiomyocytes. CONCLUSIONS Our study shows the presence of early cellular and interstitial alterations in LA tissue in patients with chronic MR and sinus rhythm. These features were analogous to those of patients with AF, and suggest that macroscopic remodeling LA in the settings of MR is preceded by structural changes, paving the way to further investigation on the preventive role of early mitral valve repair.
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Affiliation(s)
- Chiara Foglieni
- Cardiovascular Research Area, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Raffaella Rusconi
- Cardiovascular Research Area, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Maria Elena Mantione
- Cardiovascular Research Area, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Gabriele Fragasso
- Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Syed FF, Oral H. Electrophysiological Perspectives on Hybrid Ablation of Atrial Fibrillation. J Atr Fibrillation 2015; 8:1290. [PMID: 27957227 DOI: 10.4022/jafib.1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022]
Abstract
To overcome limitations of minimally invasive surgical ablation as a standalone procedure in eliminating atrial fibrillation (AF), hybrid approaches incorporating adjunctive endovascular catheter ablation have been proposed in recent years. The endovascular component targets residual conduction gaps and identifies additional electrophysiological targets with the goal of minimizing recurrent atrial arrhythmia. We performed a systematic review of published studies of hybrid AF ablation, analyzing 432 pooled patients (19% paroxysmal, 29% persistent, 52% long-standing persistent) treated using three different approaches: A. bilateral thoracoscopy with bipolar radiofrequency (RF) clamp-based approach; B. right thoracoscopic suction monopolar RF catheter-based approach; and C. subxiphoid posterior pericardioscopic ("convergent") approach. Freedom from recurrence off antiarrhythmic medications at 12 months was seen in 88.1% [133/151] for A, 73.4% [47/64] for B, and 59.3% [80/135] for C, with no significant difference between paroxysmal (76.9%) and persistent/long-standing persistent AF (73.4%). Death and major surgical complications were reported in 8.5% with A, 0% with B and 8.6% with C. A critical appraisal of hybrid ablation is presented, drawing from experiences and insights published over the years on catheter ablation of AF, with a discussion of the rationale underlying hybrid ablation, its strengths and limitations, where it may have a unique role in clinical management of patients with AF, which questions remain unanswered and areas for further investigation.
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Affiliation(s)
- Faisal F Syed
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
| | - Hakan Oral
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
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Kainuma S, Mitsuno M, Toda K, Funatsu T, Nakamura T, Miyagawa S, Yoshikawa Y, Fukushima S, Yoshioka D, Saito T, Nishi H, Takahashi T, Sakaki M, Monta O, Matsue H, Masai T, Sakaguchi T, Yoshitaka H, Ueno T, Kuratani T, Daimon T, Taniguchi K, Miyamoto Y, Sawa Y. Dilated left atrium as a predictor of late outcome after pulmonary vein isolation concomitant with aortic valve replacement and/or coronary artery bypass grafting. Eur J Cardiothorac Surg 2015; 48:765-77; discussion 777. [DOI: 10.1093/ejcts/ezu532] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 12/10/2014] [Indexed: 11/14/2022] Open
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Zhu D, Wu Z, van der Geest RJ, Luo Y, Sun J, Jiang J, Chen Y. Accuracy of Late Gadolinium Enhancement - Magnetic Resonance Imaging in the Measurement of Left Atrial Substrate Remodeling in Patients With Rheumatic Mitral Valve Disease and Persistent Atrial Fibrillation -. Int Heart J 2015; 56:505-10. [PMID: 26370371 DOI: 10.1536/ihj.15-098] [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] [Indexed: 02/05/2023]
Affiliation(s)
- Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | | | - Yong Luo
- Department of Radiology, West China Hospital, Sichuan University
| | - Jiayu Sun
- Department of Cardiology, West China Hospital, Sichuan University
| | - Jian Jiang
- Department of Cardiology, West China Hospital, Sichuan University
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University
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Gasparovic H, Cikes M, Kopjar T, Hlupic L, Velagic V, Milicic D, Bijnens B, Colak Z, Biočina B. Atrial apoptosis and fibrosis adversely affect atrial conduit, reservoir and contractile functions. Interact Cardiovasc Thorac Surg 2014; 19:223-30; discussion 230. [PMID: 24722519 DOI: 10.1093/icvts/ivu095] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chronic atrial volume overload and atrial fibrillation (AF) induce structural changes within atrial myocardium. The aim of this study was to evaluate the effect of adverse cellular remodelling on echocardiographic strain rate (SR) deformation indices of atrial contractile, conduit and reservoir functions. METHODS Forty-four consecutive patients with organic mitral regurgitation were analysed. Twenty-eight patients had long-standing persistent AF (AF group), while 16 were in normal sinus rhythm (NSR group). Left atrial (LA) samples were harvested from all the patients for histological analysis. Postoperative echocardiographic data acquisition was performed exclusively during organized atrial electrical activity in order to assess the contractile reserve of patients from both groups. RESULTS Fibrotic atria had inferior conduit (SR-E: r = -0.36, P = 0.017), reservoir (SR-S: r = -0.31, P = 0.041) and contractile functions (SR-A: r = -0.33, P = 0.027). Analogously, atria with greater apoptotic burdens showed a negative correlation with multiple indices of left atrial functions (SR-E: r = -0.38, P = 0.010; SR-S: r = -0.33, P = 0.028; SR-A: r = -0.28, P = 0.067). The efficiency of atrial contractility was significantly reduced among AF-group patients after conversion to sinus rhythm, when compared with patients in the NSR group (LA active emptying fraction: 20 ± 12 vs 30 ± 10%, P = 0.004; SR-A: 1.1 ± 1.0 vs 2.8 ± 1.9 s(-1), P < 0.001). Superior strain-rate indices of atrial conduit and reservoir functions were noted in the NSR group (SR-E: 3.5 ± 2.3 vs 1.3 ± 1.0 s(-1), P < 0.001; LA expansion index: 86 ± 31 vs 60 ± 42%, P = 0.004). Fibrosis was evident in 7.2 [3.3;9.4]% of the LA tissue sample in the AF group, while it accounted for 3.4 [1.2;8.1]% of atrial tissue in the NSR group (P = 0.054). Apoptosis was documented in 13 (46%) patients in the AF group, whereas none of the patients in the NSR group exhibited signs of programmed cell death (P = 0.001). Myocyte degeneration was more prevalent in the AF group (odds ratio: 7.0, 95% confidence interval: 1.3-36.7, P = 0.021). Age showed a positive correlation with worsening degrees of atrial fibrosis and apoptosis (r = 0.41, P = 0.006; r = 0.49, P = 0.001, respectively). Multiple regression analysis identified SR-S (β = -1.263, P = 0.036) and age (β = 0.144, P = 0.057) as independent predictors of fibrosis. Independent determinants of apoptosis were preoperative AF (β = 4.539, P = 0.007), age (β = 0.188, P = 0.009) and SR-S (β = -1.780, P = 0.002). CONCLUSIONS Atria exhibiting greater fibrotic and apoptotic burdens had impaired conduit, reservoir and contractile function, as evaluated by deformation imaging. Among patients with chronic LA volume overload, exposure to long-standing persistent AF induced more pronounced degrees of adverse atrial cellular remodelling. Strain-rate descriptors of atrial reservoir function harboured potential to predict atrial fibrosis and apoptosis.
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Affiliation(s)
- Hrvoje Gasparovic
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maja Cikes
- Department of Cardiology, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Tomislav Kopjar
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ljiljana Hlupic
- Department of Pathology, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vedran Velagic
- Department of Cardiology, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Davor Milicic
- Department of Cardiology, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Bart Bijnens
- ICREA - Universitat Pompeu Fabra, Barcelona, Spain
| | - Zeljko Colak
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Bojan Biočina
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
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McGann C, Akoum N, Patel A, Kholmovski E, Revelo P, Damal K, Wilson B, Cates J, Harrison A, Ranjan R, Burgon NS, Greene T, Kim D, Dibella EVR, Parker D, Macleod RS, Marrouche NF. Atrial fibrillation ablation outcome is predicted by left atrial remodeling on MRI. Circ Arrhythm Electrophysiol 2013; 7:23-30. [PMID: 24363354 DOI: 10.1161/circep.113.000689] [Citation(s) in RCA: 277] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although catheter ablation therapy for atrial fibrillation (AF) is becoming more common, results vary widely, and patient selection criteria remain poorly defined. We hypothesized that late gadolinium enhancement MRI (LGE-MRI) can identify left atrial (LA) wall structural remodeling (SRM) and stratify patients who are likely or not to benefit from ablation therapy. METHODS AND RESULTS LGE-MRI was performed on 426 consecutive patients with AF without contraindications to MRI before undergoing their first ablation procedure and on 21 non-AF control subjects. Patients were categorized by SRM stage (I-IV) based on the percentage of LA wall enhancement for correlation with procedure outcomes. Histological validation of SRM was performed comparing LGE-MRI with surgical biopsy. A total of 386 patients (91%) with adequate LGE-MRI scans were included in the study. After ablation, 123 patients (31.9%) experienced recurrent atrial arrhythmias during the 1-year follow-up. Recurrent arrhythmias (failed ablations) occurred at higher SRM stages with 28 of 133 (21.0%) in stage I, 40 of 140 (29.3%) in stage II, 24 of 71 (33.8%) in stage III, and 30 of 42 (71.4%) in stage IV. In multivariate analysis, ablation outcome was best predicted by advanced SRM stage (hazard ratio, 4.89; P<0.0001) and diabetes mellitus (hazard ratio, 1.64; P=0.036), whereas increased LA volume and persistent AF were not significant predictors. LA wall enhancement was significantly greater in patients with AF versus non-AF controls (16.6±11.2% versus 3.1±1.9%; P<0.0001). Histological evidence of remodeling from surgical biopsy specimens correlated with SRM on LGE-MRI. CONCLUSIONS Atrial SRM is identified on LGE-MRI, and extensive LGE (≥30% LA wall enhancement) predicts poor response to catheter ablation therapy for AF.
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Affiliation(s)
- Christopher McGann
- Comprehensive Arrhythmia Research and Management Center, Division of Cardiology, Department of Surgery, Department of Radiology, Scientific Computing and Imaging Institute, Bioengineering, Department of Pathology, and Division of Epidemiology, University of Utah Health Sciences Center, Salt Lake City
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Nishi H, Sakaguchi T, Miyagawa S, Yoshikawa Y, Fukushima S, Saito S, Ueno T, Kuratani T, Sawa Y. Impact of microRNA expression in human atrial tissue in patients with atrial fibrillation undergoing cardiac surgery. PLoS One 2013; 8:e73397. [PMID: 24069193 PMCID: PMC3772020 DOI: 10.1371/journal.pone.0073397] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 07/19/2013] [Indexed: 12/15/2022] Open
Abstract
Background Although microRNA (miRNA) regulates initiation and/or progression of atrial fibrillation (AF) in canine AF models, the underlying mechanism in humans remains unclear. We speculated that certain miRNAs in atrial tissue are related to AF, and evaluated the relationship of miRNA expression in human atrial tissue in cardiac surgery patients. Methods Right atrial tissues from 29 patients undergoing cardiovascular surgery were divided into 3 groups [A: chronic AF or unsuccessful maze, n=6; B: successful maze, n=10; C: sinus rhythm (SR) n=13]. miRNA expression was determined using high density microarrays and with Reverse transcriptase-polymerase chain reaction (RT-PCR). Fibrosis was examined using Masson trichrome staining. Results miRNA microarray analysis showed elevated miRNA-21, miRNA-23b, miRNA-199b, and miRNA-208b in AF as compared to SR groups. RT-PCR showed elevated miRNA-21 (1.9-fold) and miRNA-208b (4.2-fold) in AF as compared to the SR groups. miRNA-21 expression increased from Group C to A (A: 2.1-fold, B: 1.8-fold, C: 1.0-fold). Fibrosis increased from C to A (A: 43.0±12.9%, B: 21.3±6.1%, C: 11.9±3.1%). Percent fibrosis and miRNA-21 expression were correlated (r=0.508, p<0.05). The plasma levels of miRNA-21 in AF patients was significantly decreased as compared to the healthy volunteers (p<0.05). Conclusion The expression of miRNA-21 in human atrial tissue was found to be related to atrial fibrosis and might affect AF occurrence, indicating its usefulness as a biomarker for cardiac surgery management.
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Affiliation(s)
- Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- * E-mail:
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Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease. J Interv Card Electrophysiol 2013; 38:85-93. [PMID: 24026967 DOI: 10.1007/s10840-013-9820-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was conducted to investigate the degree of fibrosis in atrial appendages of patients with and without atrial fibrillation (AF) undergoing cardiac surgery. In addition, we hypothesized that areas of atrial fibrosis can be identified by electrogram fractionation and low voltage for potential ablation therapy. METHODS Interstitial fibrosis from right (RAA) and/or left atrial appendages (LAA) was studied in patients with sinus rhythm (SR, n = 8), paroxysmal (n = 21), and persistent AF (n = 20) undergoing coronary artery bypass and/or aortic or mitral valve surgery. Atrial fibrosis quantification was performed with Masson trichrome staining. Intraoperative bipolar epicardial electrophysiological measurements were performed to correlate fibrosis to electrogram fractionation, voltage, and AF cycle length. RESULTS The average degree of fibrosis was 11.2 ± 7.2 % in the LAA and 22.8 ± 7.6 % in the RAA (p < 0.001). Fibrosis was not significantly higher in paroxysmal AF patients compared to SR subjects (18.2 ± 8.7 versus 20.7 ± 5.3 %). Persistent AF patients had a higher degree of LAA and RAA fibrosis compared to paroxysmal AF patients (LAA 14.6 ± 8.7 versus 8.6 ± 4.7 %, p = 0.02, and RAA 28.2 ± 7.9 versus 18.2 ± 8.7 %, respectively, p = 0.04). The left atrial end diastolic volume index was higher in persistent AF patients compared to SR controls (38.3 ± 16.4 and 28 ± 11 ml/m(2), respectively, p = 0.04). No correlation between atrial fibrosis and electrogram fractionation or voltage was found. CONCLUSION Patients with structural heart disease undergoing cardiac surgery have more fibrosis in the RAA than in the LAA. Furthermore, RAA fibrosis is increased in persistent AF but not paroxysmal AF patients compared to control subjects. Electrogram fractionation and low voltage did not provide accurate identification of the fibrotic substrate.
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Beinart R, Khurram IM, Liu S, Yarmohammadi H, Halperin HR, Bluemke DA, Gai N, van der Geest RJ, Lima JAC, Calkins H, Zimmerman SL, Nazarian S. Cardiac magnetic resonance T1 mapping of left atrial myocardium. Heart Rhythm 2013; 10:1325-31. [PMID: 23643513 DOI: 10.1016/j.hrthm.2013.05.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) T1 mapping is an emerging tool for objective quantification of myocardial fibrosis. OBJECTIVES To (a) establish the feasibility of left atrial (LA) T1 measurements, (b) determine the range of LA T1 values in patients with atrial fibrillation (AF) vs healthy volunteers, and (c) validate T1 mapping vs LA intracardiac electrogram voltage amplitude measures. METHODS CMR imaging at 1.5 T was performed in 51 consecutive patients before AF ablation and in 16 healthy volunteers. T1 measurements were obtained from the posterior LA myocardium by using the modified Look-Locker inversion-recovery sequence. Given the established association of reduced electrogram amplitude with fibrosis, intracardiac point-by-point bipolar LA voltage measures were recorded for the validation of T1 measurements. RESULTS The median LA T1 relaxation time was shorter in patients with AF (387 [interquartile range 364-428] ms) compared to healthy volunteers (459 [interquartile range 418-532] ms; P < .001) and was shorter in patients with AF with prior ablation compared to patients without prior ablation (P = .035). In a generalized estimating equations model, adjusting for data clusters per participant, age, rhythm during CMR, prior ablation, AF type, hypertension, and diabetes, each 100-ms increase in T1 relaxation time was associated with 0.1 mV increase in intracardiac bipolar LA voltage (P = .025). CONCLUSIONS Measurement of the LA myocardium T1 relaxation time is feasible and strongly associated with invasive voltage measures. This methodology may improve the quantification of fibrotic changes in thin-walled myocardial tissues.
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Affiliation(s)
- Roy Beinart
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland MD 21287, USA.
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Shiina Y, Matsuyama TA, Adachi I, Li W, Gatzoulis MA, Uemura H. Surgery in a contemporary adult cohort of patients with Ebstein malformation of tricuspid valve and relation with ECG markers, atrial fibrosis and arrhythmic load. Int J Cardiol 2013; 168:1551-2. [PMID: 23290082 DOI: 10.1016/j.ijcard.2012.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/08/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Yumi Shiina
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, United Kingdom.
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Qian Y, Liu Y, Tang H, Zhou W, Jiang L, Li Y, Li N, Li M, Xiao X. Circulating and local renin-angiotensin-aldosterone system express differently in atrial fibrillation patients with different types of mitral valvular disease. J Renin Angiotensin Aldosterone Syst 2012; 14:204-11. [PMID: 23077077 DOI: 10.1177/1470320312460897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Mitral valvular disease is strongly related to atrial fibrillation (AF), but the different types of mitral valvular disease have a different prevalence of AF. In this study we explored the expressions of the circulating and local renin-angiotensin-aldosterone system (RAAS) in order to determine the relationship between circulating and local RAAS expressions and its effects on AF in different types of mitral valvular disease patients. Our study group consisted of 24 mitral valvular disease patients scheduled for mitral valve replacement surgery. Peripheral blood samples and left atrial appendage tissue samples were obtained from all patients. Radioimmunoassay was performed to assess the expression levels of circulating and local renin, angiotensin II and aldosterone. In mitral valvular diseases, linear correlation analyses were done for local and circulating renin, angiotensin II and aldosterone; the p values were 0.979, 0.518 and 0.125, respectively. Expression levels of local angiotensin II, circulating angiotensin II and local aldosterone were significantly increased in the AF group compared with sinus rhythm; the p values were 0.023, 0.042 and 0.035, respectively. In mitral stenosis patients, AF was primarily associated with local angiotensin II (p=0.010), as well as being associated with circulating angiotensin II (p=0.038). In mitral regurgitation patients, AF was only significantly associated with local angiotensin II (p=0.038). Circulating and local RAAS expressions are associated with AF in mitral valvular disease patients. The levels of circulating and local RAAS expressions were different in AF patients with different types of mitral valvular diseases. The differentiation of circulating and local RAAS expression levels in AF patients between different types of mitral valvular disease can potentially improve the specific pharmacological interventions outcomes for these patients.
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Affiliation(s)
- Yongjun Qian
- Division of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, China
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Vohra HA, Whistance RN, Magan A, Sadeque SA, Livesey SA. Mitral valve repair for severe mitral regurgitation secondary to lone atrial fibrillation. Eur J Cardiothorac Surg 2012; 42:634-7. [DOI: 10.1093/ejcts/ezs029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Uldry L, Van Zaen J, Prudat Y, Kappenberger L, Vesin JM. Measures of spatiotemporal organization differentiate persistent from long-standing atrial fibrillation. Europace 2012; 14:1125-31. [PMID: 22308083 DOI: 10.1093/europace/eur436] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS This study presents an automatic diagnostic method for the discrimination between persistent and long-standing atrial fibrillation (AF) based on the surface electrocardiogram (ECG). METHODS AND RESULTS Standard 12-lead ECG recordings were acquired in 53 patients with either persistent (N= 20) or long-standing AF (N= 33), the latter including both long-standing persistent and permanent AF. A combined frequency analysis of multiple ECG leads followed by the computation of standard complexity measures provided a method for the quantification of spatiotemporal AF organization. All possible pairs of precordial ECG leads were analysed by this method and resulting organization measures were used for automatic classification of persistent and long-standing AF signals. Correct classification rates of 84.9% were obtained, with a predictive value for long-standing AF of 93.1%. Spatiotemporal organization as measured in lateral precordial leads V5 and V6 was shown to be significantly lower during long-standing AF than persistent AF, suggesting that time-related alterations in left atrial electrical activity can be detected in the ECG. CONCLUSION Accurate discrimination between persistent and long-standing AF based on standard surface recordings was demonstrated. This information could contribute to optimize the management of sustained AF, permitting appropriate therapeutic decisions and thereby providing substantial clinical cost savings.
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Affiliation(s)
- Laurent Uldry
- Applied Signal Processing Group, Swiss Federal Institute of Technology, EPFL STI GR-SCI-STI SCI-STI-JMV, ELD 234-Bâtiment ELD, CH-1015 Lausanne, Switzerland.
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Gelsomino S, La Meir M, Lucà F, Lorusso R, Crudeli E, Vasquez L, Gensini GF, Maessen J. Treatment of lone atrial fibrillation: a look at the past, a view of the present and a glance at the future. Eur J Cardiothorac Surg 2012; 41:1284-94. [PMID: 22233800 DOI: 10.1093/ejcts/ezr222] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sandro Gelsomino
- Department of Cardiothoracic Surgery, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
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