scholarly journals Clinical impact of left atrial enlargement in Korean patients with atrial fibrillation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Soo Cho ◽  
Hyoung-Seob Park ◽  
Myung-Jin Cha ◽  
So-Ryoung Lee ◽  
Jin-Kyu Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Clinical Impact ◽  
Volume Index ◽  
Systemic Embolism ◽  
Korean Patients ◽  
Atrial Enlargement ◽  
Anterior Posterior

AbstractWe sought to evaluate the clinical implication of LAE based on left atrial anterior–posterior (LA AP) dimension or LA volume index (LAVI) in Korean patients with atrial fibrillation (AF). We enrolled 8159 AF patients from the CODE-AF registry. The primary outcome was rate of stroke or systemic embolism (SSE). The prevalence of mild, moderate, and severe LAE by LA AP dimension was 30.6%, 18.5%, and 21.4%, and by LAVI (available in 5808 patients) was 15.7%, 12.5% and 37.8%, respectively. Compared with no or mild LAE, patients with significant LAE (moderate to severe LAE, n = 3258, 39.9%) were associated with a higher rate of SSE (2.5% vs. 1.4%, P = 0.001). Multivariable analysis suggested presence of significant LAE by LA AP dimension was associated with a higher risk of SSE in the overall population (HR 1.57, 95% CI: 1.14–2.17, P = 0.005) and in patients using anticoagulants (n = 5836, HR 1.79, 95% CI: 1.23–2.63, P = 0.002). Patients with significant LAE by LAVI were also at higher risk of SSE (HR 1.58, 95% CI: 1.09–2.29, P = 0.017). In conclusion, significant LAE by LA dimension or LAVI was present in 39.9% and 50.2% of AF patients, respectively, and was associated with a higher rate of SSE.

scholarly journals Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium

2021 ◽  
Author(s):  
Jolien Neefs ◽  
Robin Wesselink ◽  
Nicoline W. E. van den Berg ◽  
Jonas S. S. G. de Jong ◽  
Femke R. Piersma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Antiarrhythmic Drugs ◽  
Primary Outcome ◽  
Volume Index ◽  
Substantial Part ◽  
Atrial Tachyarrhythmia ◽  
Af Ablation ◽  
Male Patients

Abstract Purpose Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA. Methods Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI) ≥ 50 ml/m2. Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up. Results At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4–62.8] ml/m2), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2–41.3] ml/m2). GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8–49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8–47.4 in a combined group of GLA and/or female sex(log rank p = 0.02). Conclusion Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.

P5658Incorporation of severity of left atrial enlargement in clinical risk factors improves identification of patients at risk for development of atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Chawla ◽  
S Olet ◽  
M E Mortada ◽  
J Zilinski ◽  
K A Ammar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
At Risk ◽  
Left Atrial ◽  
Roc Analysis ◽  
Roc Curves ◽  
Volume Index ◽  
Clinical Predictors ◽  
Left Atrial Enlargement ◽  
Patients At Risk ◽  
Atrial Enlargement

Abstract Background Early identification of patients at risk for atrial fibrillation (AF) is desirable to prevent its development and complications. Clinical predictors have been recognized but need refinement to improve predictability. We evaluated whether severity of left atrial enlargement (LAE) added to a scoring system (CHA2DS2VASC) in an unselected non-AF population improves risk stratification for incident AF. Purpose To assess the incremental benefit of LAE severity added to CHA2DS2VASc in predicting future AF in non-AF patients. Methods From 2012–2017, consecutive adult patients with an echocardiogram and no prior AF were identified. CHA2DS2VASc was used to define baseline AF risk, and the incremental risk of AF with addition of LAE was assessed through increased LA volume index (LAVI; moderate 42–48 ml/m2, severe >48 ml/m2). To quantify improvement in risk prediction, logistic regression model was fitted and odds ratios (OR) and ROC curves obtained. Results Out of 155,597 patients with no prior AF, 13.8% developed AF over 1.5±1.3 years. OR for AF with CHA2DS2VASc was 1.68 (95% CI 1.66–1.69). With addition of moderately or severely increased LAVI to the model, OR for AF increased to 2.3 (2.2–2.5) and 3.8 (3.6–4.0), respectively. ROC analysis showed c-statistics of 0.66 with CHA2DS2VASc, 0.63 with LAVI, and 0.71 with incorporation of both (Fig). AF CHAD score Conclusion(s) In non-AF patients, predictability for future AF can be improved by using clinical factors (CHA2DS2VASc) and increased LAVI. This information may guide closer monitoring and initiation of therapies to prevent progression to AF or stroke. Acknowledgement/Funding None

scholarly journals Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Yasuhiro Hamatani ◽  
Hisashi Ogawa ◽  
Kensuke Takabayashi ◽  
Yugo Yamashita ◽  
Daisuke Takagi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Independent Predictor ◽  
Systemic Embolism ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

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

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.

Remote monitoring and early detection of sub-clinical atrial fibrillation in implantable cardioverter defibrillator recipients: incidence, risk factors and prognostic significance (Preprint)

2018 ◽  
Author(s):  
Elodie Surget ◽  
Claude Kouakam ◽  
Ninni Sandro ◽  
Loic Finat ◽  
Cédric Klein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Remote Monitoring ◽  
Left Atrial ◽  
Thyroid Dysfunction ◽  
Anticoagulation Therapy ◽  
Systemic Embolism ◽  
Cardioverter Defibrillator ◽  
Hemorrhagic Complications ◽  
Atrial Enlargement

BACKGROUND Atrial high rate episodes (AHREs) detected by cardiac electronic implantable devices are common. They are significantly associated with mortality and morbidity due to systemic embolism and ischemic stroke. Much earlier detection of AHREs might allow the timely introduction of therapies to protect the patient. OBJECTIVE The aim of this study was to determine the incidence and risk factors of AHREs in patients with implantable defibrillator in the era of remote monitoring (RM), and to analyze the choice of anticoagulant treatment strategies and its potential complications. METHODS 1226 patients with implantable cardioverter defibrillator remotely followed-up were prospectively included from January 2009 to December 2016 at Lille University Hospital. The first phase of the study focuses primarily on the incidence and risk factors of AHREs and the second analysis was confined to patients presenting at least one AHRE. Survey analysis was determined using the Kaplan-Meier method and compared between groups with the Logrank test. RESULTS Among the 1226 patients, 63 presented at least one AHRE detected by RM which corresponds to an incidence of 5.14%. In ¾ of cases, the AHRE was completely asymptomatic. In the remaining quarter, the most common symptom was dyspnea. The main precipitating factor was infection. AHRE risk factors were thyroid dysfunction (p = 0.0047) and left atrial enlargement (p = 0.0317). None of these factors were associated with atrial fibrillation duration. The mean CHA2DS2-VASc score was 2.64 ± 1.38. Oral anticoagulation therapy was introduced in 47 patients (88.7%). The incidence of thromboembolic events was 1.6% and that of anticoagulation-related hemorrhagic complications was 8.5% (n = 4) with ¾ major. CONCLUSIONS AHRE is a common disease. Risk factors are thyroid dysfunction and left atrial enlargement. Its thromboembolism risk seems to be low. The introduction of anticoagulation therapy is based on the evaluation of clinical risk scores for systemic embolism and its indication must be regularly assessed because hemorrhagic complications are common.

Abstract 12799: Left Atrial Enlargement is an Independent Risk Factor of Stroke or Systemic Embolism in Atrial Fibrillation Patients: The Fushimi AF Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yasuhiro Hamatani ◽  
Daisuke Takagi ◽  
Hisashi Ogawa ◽  
Masahiro Esato ◽  
Yeong-Hwa Chun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Left Atrial ◽  
Systemic Embolism ◽  
Left Atrial Diameter ◽  
Left Atrial Enlargement ◽  
Valvular Heart Diseases ◽  
Increased Risk ◽  
Atrial Enlargement

Introduction: Atrial fibrillation (AF) is a common arrhythmic disorder and increasing significantly. Stroke or systemic embolism (SE) is a devastating complication of AF. Controversy exists regarding whether left atrial enlargement is a risk factor of stroke/SE in AF patients. Hypothesis: Left atrial enlargement might be associated with the incidence of stroke/SE. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, which represented a typical urban community in Japan. We started to enroll patients from March 2011, and follow-up data were available for 2,724 patients by April 2015 (median follow-up period 808 days). Left atrial enlargement (LAE) was diagnosed if the left atrial diameter measured by transthoracic echocardiography was >45 mm. We compared the backgrounds and incidences of events during follow-up period between those with LAE and those without it (non-LAE). Results: Backgrounds and incidences of events between LAE and non-LAE are shown in the Table. LAE group showed higher incidence of stroke/SE during follow-up period, compared with non-LAE group (hazard ratio (HR): 1.81, 95% confidence interval (CI): 1.29-2.57, p<0.01). After adjustment by the components of CHADS2 score and oral anticoagulant prescription, LAE was independently associated with higher risk for stroke/SE (HR: 1.70, 95% CI: 1.20-2.43, p<0.01). This was also the case when we defined cut-off as 40 mm (HR: 1.67, 95% CI: 1.12-2.55, p=0.01), and as 50 mm (HR: 1.58, 95% CI: 1.08-2.29, p=0.02), or we analyzed left atrial diameter as continuous variables (HR (per 1mm): 1.03, 95% CI: 1.01-1.05, p<0.01). Even after adjustment by type of AF (paroxysmal or sustained) and valvular heart diseases, LAE remained to be independently associated with the risk of stroke/SE (HR: 1.57, 95% CI: 1.08-2.31, p=0.02). Conclusion: Left atrial enlargement was independently associated with the increased risk of stroke/SE in AF patients.

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

2021 ◽  
Author(s):  
T. Shchetynska-Marinova ◽  
M. Kranert ◽  
S. Baumann ◽  
V. Liebe ◽  
A. Grafen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Arterial Stiffness ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Volume Index ◽  
Left Atrial Size ◽  
Atrial Size ◽  
Af Recurrence

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.

Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Shiraki ◽  
H Tanaka ◽  
K Yamashita ◽  
Y Tanaka ◽  
K Sumimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Anticoagulation Therapy ◽  
Left Ventricular ◽  
Volume Index ◽  
Oral Anticoagulation Therapy

Abstract Background Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy. Purpose Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy. Methods We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists. Results Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p&lt;0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95. Conclusions LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially &lt;15cm/s. Funding Acknowledgement Type of funding source: None

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