High‐Density Mapping of Left Atrial Endocardial Activation During Sinus Rhythm and Coronary Sinus Pacing in Patients with Paroxysmal Atrial Fibrillation

AbstractThe pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.

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SIGNIFICANCE OF TRIGGERS FROM LEFT ATRIAL APPENDAGE AND CORONARY SINUS IN THE LONG-TERM ABLATION OUTCOME IN PAROXYSMAL ATRIAL FIBRILLATION PATIENTS WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)30891-x ◽

2018 ◽

Vol 71 (11) ◽

pp. A350

Author(s):

Sanghamitra Mohanty ◽

Chintan Trivedi ◽

Carola Gianni ◽

Domenico Giovanni Della Rocca ◽

John Burkhardt ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Sinus ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Atrial Appendage

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Paradoxical doppler echocardiographic parameters during recovery of left atrial contractility after spontaneous conversion from paroxysmal atrial fibrillation to sinus rhythm

Journal of Cardiology Cases ◽

10.1016/j.jccase.2020.08.003 ◽

2020 ◽

Vol 22 (6) ◽

pp. 302-304

Author(s):

Hironori Murakami ◽

Daisuke Hotta ◽

Gregory W. Ruhnke

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Echocardiographic Parameters ◽

Spontaneous Conversion

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P3778Long-term outcome of non-pharmacologial treatment of atrial fibrillation in hypertrophic cardiomyopathy: a large single-centre experience

European Heart Journal ◽

10.1093/eurheartj/ehz745.0627 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Dinshaw ◽

M Lemoine ◽

J Hartmann ◽

B Schaeffer ◽

N Klatt ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

High Density ◽

Term Outcome ◽

Long Term Outcome ◽

Density Mapping ◽

Ablation Success

Abstract Introduction Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is generally associated with a significant deterioration of clinical status. Non-pharmacological treatment such as surgical and catheter ablation has become an established therapy for symptomatic AF but in patients with HCM often having a chronically increased left atrial pressure and extensive atrial cardiomyopathy the long-term outcome is uncertain. Purpose The present study aimed to analyse the long-term outcome of AF ablation in HCM and the mechanism of recurrent atrial arrhythmias using high-density mapping systems. Methods A total of 65 patients (age 64.5±9.9 years, 42 (64.6%) male) with HCM undergoing AF ablation for symptomatic AF were included in our study. The ablation strategy for catheter ablation included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines if appropriate. In patients with suspected atrial tachycardia (AT) high-density activation and substrate mapping were performed. A surgical ablation at the time of an operative myectomy for left ventricular outflow tract obstruction was performed in 8 (12.3%) patients. The outcome was analysed using clinical assessment, Holter ECG and continuous rhythm monitoring of cardiac implantable electric devices. Results Paroxysmal AF was present in 27 (41.6%), persistent AF in 37 (56.9%) and primary AT in 1 (1.5%) patients. The mean left atrial diameter was 54.1±12.5 ml. In 11 (16.9%) patients with AT high-density mapping was used to characterize the mechanism of the ongoing tachycardia. After 1.9±1.2 ablation procedures and a follow-up of 48.5±37.2 months, ablation success was demonstrated in 58.9% of patients. The success rate for paroxysmal and persistent AF was 70.0% and 55.8%, respectively (p=0.023). Of those patients with AT high-density mapping guided ablation was successful in 44.4% of patients. The LA diameter of patients with a successful ablation was smaller (52.2 vs. 58.1 mm; p=0.003). Conclusion Non-pharmacological treatment of AF in HCM is effective during long-term follow-up. Paroxysmal AF and a smaller LA diameter are favourable for successful ablation. In patients with complex AT the use of high-density mapping can guide ablation resulting in further ablation success in a reasonable number of patients.

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