Recurrence of atrial fibrillation after pulmonary vein isolation in dependence of arterial stiffness

Abstract Background Arterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Although increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated. Methods Patients with AF who underwent pulmonary vein isolation (PVI) were included in this study. Presence of AS was evaluated by measuring aortic distensibility (AD) of the descending aorta by transoesophageal echocardiography. Results In total, 151 patients (mean ± standard deviation (SD) age 71.9 ± 9.8 years) were enrolled and followed for a median duration of 21 months (interquartile range 15.0–31.0). During follow-up, AF recurred in 94 (62.3%) patients. AF recurrence was seen more frequently in patients with permanent AF (27% vs 46%, p = 0.03) and in those who had undergone prior PVI (9% vs 23%, p = 0.02). AD was significantly reduced in patients with AF recurrence (mean ± SD 2.6 ± 2.3 vs 1.5 ± 0.7 × 10−3 mm Hg−1, p < 0.0001), as well as left atrial volume index (LAVI) (mean ± SD 29 ± 12 vs 44 ± 15 ml/m2, p < 0.0001). Multivariable analysis revealed LAVI (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2–3.4) and AS (OR 3.6, 95% CI 2.8–4.1) as independent risk factors of AF recurrence. Conclusion Increased AS and left atrial size were independent predictors of AF recurrence after PVI. AD as surrogate marker of AS seemed to reflect the overall CV risk. In addition, AD was significantly correlated with left atrial size, which suggests that increased AS leads to atrial remodelling and thus to AF recurrence. Trial registration German registry for clinical studies (DRKS), DRKS00019007.

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P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0000000000000220 ◽

2016 ◽

Vol 17 (3) ◽

pp. 194-200 ◽

Cited By ~ 18

Author(s):

Giacomo Mugnai ◽

Gian-Battista Chierchia ◽

Carlo de Asmundis ◽

Justo Juliá ◽

Giulio Conte ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

P Wave ◽

Atrial Fibrillation Recurrence ◽

Left Atrial Size ◽

Atrial Size

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Influence of left atrial size on the outcome of pulmonary vein isolation in patients with atrial fibrillation

Kardiologia Polska ◽

10.5603/kp.a2014.0135 ◽

2014 ◽

pp. 1135-1140 ◽

Cited By ~ 3

Author(s):

Marek Kiliszek ◽

Nina Miązek ◽

Michał Peller ◽

Sylwia Gajda ◽

Edward Koźluk ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Left Atrial Size ◽

Atrial Size

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Two and three-dimensional echocardiographic assessment of left atrial size in patients with atrial fibrillation treated with pulmonary vein isolation

Cardiologia Croatica ◽

10.15836/ccar2016.420 ◽

2016 ◽

Vol 11 (10-11) ◽

pp. 420-420

Author(s):

Nikola Bulj ◽

Kristijan Đula ◽

Vjekoslav Radeljić ◽

Nikola Pavlović ◽

Šime Manola ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Three Dimensional ◽

Left Atrial Size ◽

Atrial Size ◽

Echocardiographic Assessment

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Impact of left atrial size on isolation area in the acute phase of pulmonary vein isolation using 28 mm cryoballoon

Pacing and Clinical Electrophysiology ◽

10.1111/pace.13337 ◽

2018 ◽

Vol 41 (7) ◽

pp. 700-706 ◽

Cited By ~ 1

Author(s):

Akio Chikata ◽

Takeshi Kato ◽

Kazuo Usuda ◽

Shuhei Fujita ◽

Michiro Maruyama ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Acute Phase ◽

Left Atrial ◽

Left Atrial Size ◽

Atrial Size

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2140Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0087 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Yoshida ◽

K Nakanishi ◽

M Daimon ◽

J Ishiwata ◽

N Sawada ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Arterial Stiffness ◽

Left Atrial ◽

Global Longitudinal Strain ◽

Multivariable Analysis ◽

Significant Risk ◽

Left Ventricular ◽

Volume Index ◽

Community Based

Abstract Background Increased arterial stiffness is recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. Cardio-ankle vascular index (CAVI) is emerging as an important tool to assess arterial stiffness noninvasively which is derived from the concept of stiffness β index and is less dependent on blood pressure at the time of measurement than pulse wave velocity. Purpose This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort. Methods We included 1,156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by CAVI. Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS). Results CAVI was negatively correlated with reservoir and conduit strain (r=−0.37 and −0.45, both p<0.001; Figure), whereas weakly, but positively correlated with LA volume index and pump strain (r=0.12 and 0.09, both p<0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized β=−0.22 and −0.26, respectively, both p<0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir (<31.4%) and conduit (<12.4%) strain (adjusted odds ratio = 2.63 and 3.71 vs. normal CAVI, both p<0.01) in a fully-adjusted model including laboratory and echocardiographic parameters. Figure 1 Conclusion Arterial stiffness was independently associated with LA reservoir and conduit function, even in the absence of overt cardiovascular disease. This association may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.

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Left Atrial Size May Predict Blood Pressure Improvement after Ganglionated Plexi Ablation in Addition to Pulmonary Vein Isolation

Journal of Atrial Fibrillation ◽

10.4022/jafib.2326 ◽

2020 ◽

Vol 13 (2) ◽

Author(s):

Dhanunjaya Lakkireddy

Keyword(s):

Blood Pressure ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Left Atrial Size ◽

Ganglionated Plexi ◽

Atrial Size

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Left Atrial Ejection Fraction Assessed by Prior Cardiac CT Predicts Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation

Journal of Clinical Medicine ◽

10.3390/jcm10040752 ◽

2021 ◽

Vol 10 (4) ◽

pp. 752

Author(s):

Reinhard Kaufmann ◽

Richard Rezar ◽

Bernhard Strohmer ◽

Bernhard Wernly ◽

Michael Lichtenauer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Cardiac Ct ◽

Cardiac Computed Tomography ◽

Youden Index ◽

Atrial Remodeling ◽

Functional Parameters ◽

Af Recurrence

Assuming that atrial fibrillation (AF) is associated with left atrial remodeling and dysfunction, we hypothesize that left atrial and left atrial appendage ejection fractions (LAEF and LAAEF) are useful and may be more sensitive outcome predictors of pulmonary vein isolation (PVI). Fifty patients who underwent PVI at our institution with available pre-interventional cardiac computed tomography (CT) for procedure planning were included in this retrospective study. The patients were separated into two groups by recurrence and non-recurrence of AF and subgroups of paroxysmal and persistent AF. Semiautomatic volumetric analysis of the left atrium was used to calculate morphological and functional parameters and optimal cut-offs were calculated using the Youden index. LAEF (accuracy 94%, sensitivity 67%) and LAAEF (accuracy 90%, sensitivity 67%) were significantly reduced in patients with AF recurrence (16% vs. 36%, p = 0.00002; 16% vs. 42%, p = 0.000002), and in the subgroup analysis, the functional parameters were independent from AF type (paroxysmal and persistent). With a cut-off of <23% for both LAEF and LAAEF (area under the curve (AUC) 0.94, 95%CI 0.84–0.99 and AUC 0.96, 95%CI 0.86–0.99, respectively), AF recurrence occurred in 77.8%, within a mean follow-up period of 229 days. In conclusion, left atrial function on prior cardiac CT offers useful parameters for predicting AF recurrence after PVI.

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