Left atrial fibrosis provides a new means of identifying patients with higher risk of new-onset heart failure among patients with atrial fibrillation

Abstract Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Catheter ablation has been reported to restore left ventricular (LV) function but patients benefit differently. This study investigated the correlation between left atrial (LA) fibrosis extent and LV ejection fraction (LVEF) recovery after AF ablation. Methods and results In this study, 103 patients [64 years, 69% men, 79% persistent AF, LVEF 33% interquartile range (IQR) (25–38)] undergoing first time AF ablation were investigated. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. Continuous rhythm monitoring was used to assess ablation success. Improvement in post-ablation LVEF was measured as primary study endpoint. An absolute increase in post-ablation LVEF ≥10% was defined as ‘Super Response’. Left atrial fibrosis was present in 38% of patients. After ablation LVEF increased by absolute 15% (IQR 6–25) (P < 0.001). Left ventricular ejection fraction improvement was higher in patients without LA fibrosis [15% (IQR 10–25) vs. 10% (IQR 0–20), P < 0.001]. An inverse correlation between LVEF improvement and the extent of LA fibrosis was found (R2 = 0.931). In multivariate analysis, the presence of LA fibrosis was the only independent predictor for failing LVEF improvement [odds ratio 7.2 (95% confidence interval 2.2–23.4), P < 0.001]. Echocardiographic ‘Super Response’ was observed in 55/64 (86%) patients without and 21/39 (54%) patients with LA fibrosis, respectively (P < 0.001). Conclusion Presence and extent of LA fibrosis predict LVEF response in HF patients undergoing AF ablation. The assessment of LA fibrosis may impact prognostic stratification and clinical management in HF patients with AF.

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LEFT ATRIAL FIBROSIS IN PATIENTS WITH ATRIAL FIBRILLATION ACCORDING TO MAGNETIC RESONANCE IMAGING WITH LATE GADOLINIUM ENHANCEMENT

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2015-43-29-37 ◽

2016 ◽

pp. 29-37 ◽

Cited By ~ 3

Author(s):

O. V. Stukalova ◽

O. P. Aparina ◽

N. A. Mironova ◽

S. P. Golitsy

Keyword(s):

Magnetic Resonance Imaging ◽

Atrial Fibrillation ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Left Atrial ◽

Resonance Imaging ◽

Atrial Fibrosis ◽

Gadolinium Enhancement ◽

Left Atrial Fibrosis

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Voltage mapping as a method of left atrial fibrosis evaluation

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-2-111-116 ◽

2016 ◽

Vol 20 (2) ◽

pp. 111 ◽

Cited By ~ 1

Author(s):

O. V. Sapelnikov ◽

Yu. A. Shuvalova ◽

D. Yu. Cherkashin ◽

A. A. Krupnov ◽

A. S. Partigulova ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Large Scale ◽

Atrial Fibrosis ◽

Instrumental Data ◽

Voltage Mapping ◽

Special Software ◽

Mechanisms Of Development ◽

Left Atrial Fibrosis ◽

And Control

Aim: This pilot study is designed to better understand the mechanisms of development and control of atrial fibrillation. Methods: The correlation between fibrosis index (FI), which was calculated intraoperatively with special software, and clinical and instrumental data was analyzed. Also evaluated were FI values as compared to AF catheter ablation outcomes. Results: Voltage mapping may be considered as a possible alternative to MRI examination and in some cases it is more informative. Conclusion: It was found out that the preliminary results received are a good start for planning a large-scale study in this area related to assessment of the predicative and practical value of the fibrosis index.

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