Effects of atrial fibrosis induced by mitral regurgitation on atrial electrophysiology and susceptibility to atrial fibrillation in pigs

Atrial fibrillation (AF) likely involves a complex interplay between triggering activity, usually from pulmonary vein foci, and maintenance of the arrhythmia by an arrhythmogenic substrate. Both components of AF, triggers and substrate have been linked to atrial fibrosis and attendant changes in atrial electrophysiology. Recently, there has been a growing use of imaging modalities, particularly cardiac magnetic resonance (CMR), to quantify the burden of atrial fibrosis and scar in patients either undergoing AF ablation, or who have recently had the procedure. How to use the CMR derived data is still an open area of investigation. The aim of this article is to summarise what is known as atrial fibrosis, as assessed by traditional catheter-based techniques and newer imaging approaches, and to report on novel efforts from our group to advance the use of CMR in AF ablation patients.

Download Full-text

Faculty Opinions recommendation of Negative impact of atrial fibrillation and pulmonary hypertension after mitral valve surgery in asymptomatic patients with severe mitral regurgitation: a 20-year follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725299911.793503220 ◽

2015 ◽

Author(s):

John Augoustides

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Hypertension ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Negative Impact ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Severe Mitral Regurgitation ◽

Asymptomatic Patients

Download Full-text

The Role of Atrial Fibrosis Detected by Delayed - Enhancement MRI in Atrial Fibrillation Ablation

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180806130327 ◽

2020 ◽

Vol 16 (2) ◽

pp. 135-144 ◽

Cited By ~ 1

Author(s):

Zsuzsanna Kis ◽

Astrid Amanda Hendriks ◽

Taulant Muka ◽

Wichor M. Bramer ◽

Istvan Kovacs ◽

...

Keyword(s):

Atrial Fibrillation ◽

Imaging Modality ◽

Final Analysis ◽

Atrial Fibrosis ◽

Atrial Wall ◽

Af Ablation ◽

Left Atrial Wall ◽

Cmr Imaging

Introduction: Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. Methods: Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). Results: Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. Conclusion: Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.

Download Full-text

Association between functional mitral regurgitation and recurrence of paroxysmal atrial fibrillation following catheter ablation: a prospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211014375 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110143

Author(s):

Fusheng Ke ◽

Yinhui Huang ◽

Zhexiu Jin ◽

Lei Huang ◽

Qiang Xiong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Cohort Study ◽

Catheter Ablation ◽

Mitral Regurgitation ◽

Confidence Interval ◽

Paroxysmal Atrial Fibrillation ◽

Prospective Cohort ◽

Radiofrequency Catheter Ablation ◽

Functional Mitral Regurgitation

Objective The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. Methods This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. Results The median duration of PAF was 24 (3–60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191–3.004; hazard ratio=0.665, 95% confidence interval: 0.134–3.300, respectively). Kaplan–Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. Conclusions FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.

Download Full-text