scholarly journals Relationship between cardiac structure and function and atrial fibrillation related hospitalizations following catheter ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F.J Olsen ◽  
S Darkner ◽  
X Chen ◽  
S Pehrson ◽  
A Johannessen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Funding Source ◽  
Risk Patients ◽  
Atrial Strain ◽  
And Function

Abstract Background Even though catheter ablation (CA) is an effective treatment for atrial fibrillation (AF), AF-related hospitalizations and cardioversions are common following this procedure. Purpose To investigate whether echocardiographic measures of left atrial (LA) function could predict AF-related hospitalizations and cardioversions. Methods This was a substudy of a trial that randomized patients to amiodarone vs place to reduce AF recurrence following CA. Transthoracic echocardiography was performed prior to CA and included assessment of: end-systolic and end-diastolic LA volumes, emptying fraction (LAEF), atrial strain, and global longitudinal strain (GLS). Poisson regression was used to assess predictive value for AF-related hospitalizations and cardioversions. Multivariable adjustments were made for: age, gender, ejection fraction, AF burden, AF subtype, dyspnea, and class 1c antiarrhythmics. Results Of the 212 patients, 80 were hospitalized for AF (206 times), and 77 were cardioverted (192 times) within the 6 months follow-up period. Mean age was 60 years, 83% were men, and mean LVEF was 50%. In univariable analyses, LA volumes, LAEF and GLS were predictors of the outcomes but did not remain significant predictors after multivariable adjustments. During echocardiography 162 patients were in sinus rhythm and 50 had AF rhythm. Rhythm during the echocardiogram modified the association between GLS and outcomes (p for interaction <0.05 for both endpoints), such that GLS predicted both AF-related hospitalizations and cardioversions in patients with sinus rhythm but not AF during the echocardiogram (figure). Conclusion Global longitudinal strain predicts AF-related hospitalizations and cardioversions after CA, but only in patients presenting in sinus rhythm during the echocardiogram. Patients presenting with impaired global longitudinal strain should be considered high-risk patients following CA who may benefit from close follow-up. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Danish Heart Foundation

Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Philabout ◽  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cardiac Rhythm ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Chamber ◽  
Deformation Imaging ◽  
And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

Abstract 6138: Two-Dimensional Atrial Strain and Strain Rate Predict Maintenance of Sinus Rhythm After Pulmonary Vein Ablation in Patients with Atrial Fibrillation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hye Jin Hwang ◽  
Sung-Ai Kim ◽  
Boyoung Joung ◽  
Eui-Young Choi ◽  
Jin-Bae Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Strain Rate ◽  
Longitudinal Strain ◽  
Af Ablation ◽  
Strain And Strain Rate ◽  
2D Strain ◽  
Atrial Strain ◽  
Sinus Rhythm Maintenance

Introduction A novel method to measure strain and strain rate from standard 2-dimensional(2D) has been developed. However, clinical usefulness of 2D atrial strain and strain rate has been not yet investigated. Hypothesis We assessed the hypothesis that 2D strain and strain rate might be reduced in patients with atrial fibrillation (AF) and predictive of maintenance of sinus rhythm after AF ablation. Methods Echocardiographic examinations were performed in 44 patients with lone AF before AF ablation. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal strain and strain rate in apical 4- and 2-chamber views. Maintenance of sinus rhythm after AF ablation was assessed during a 9 months follow-up. 2D left atrial(LA) strain and strain rate values in AF patients were compared with those of age- and sex-matched referents(N=40). Moreover, clinical and echocardiographic parameters of patients with maintenance of sinus rhythm (n=30) over the follow-up period were compared with those from patients with AF recurrence (n=14). Results All components of strain and strain rate were significantly reduced in AF patients. Average LA longitudinal strain and strain rate in patients with AF and referents were 28.1 ± 8.7 % versus 40.5 ± 6.4 and 1.8 ± 0.5 versus 2.4 ± 0.9, respectively (all p < 0.001). The individual predictors of sinus rhythm maintenance after AF ablation were paroxysmal AF(80 vs. 35.7%, p = 0.007), duration of AF (3.5 ± 3.1 vs. 5.9 ± 3.4 years, p=0.037), LA volume index(29±8 vs. 36±14ml/m2, p=0.045), average LA longitudinal strain (30.9±7.9 vs. 21.9 ± 7.3, p=0.001) and strain rate (2.0 ± 0.4 vs.1.6±0.6, p=0.008) peak systolic values. Average LA longitudinal strain parameter (OR 0.85, 95% CI 0.74–0.97, p=0.016) was confirmed as independent predictor of sinus rhythm maintenance by multivariate analysis, with a contribution from paroxysmal AF (OR 8.17, 95% CI 1.03–64.85, p=0.047). Average interobserver and intraobserver variabilities for strain and strain rate were 9.2%, 10.3%, 13.2%, and 14.1%, respectively. Conclusions Patients with higher atrial strain appear to have a greater likelihood of maintenance of sinus rhythm after AF ablation. 2D strain of LA may be helpful to select candidates of AF ablation.

Early change in left atrial and left ventricular strain predicts sinus rhythm maintenance after cardioversion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kupczynska ◽  
D Miskowiec ◽  
B Michalski ◽  
L Szyda ◽  
K Wierzbowska-Drabik ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Mechanical Function ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None

B-Type natriuretic peptide predicts major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kato ◽  
K Usuda ◽  
H Tada ◽  
T Tsuda ◽  
K Takeuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Natriuretic Peptide ◽  
Cardiovascular Events ◽  
Curve Analysis ◽  
Funding Source ◽  
Coronary Syndrome ◽  
Cerebrovascular Events

Abstract Background High plasma B-Type natriuretic peptide (BNP) level is associated with cardiac events or stroke in patients with atrial fibrillation (AF). However, it is still unknown whether BNP predicts worse clinical outcomes after catheter ablation ofAF. Purpose We aimed to see if plasma BNP level is associated with major adverse cardiac and cerebrovascular events (MACCE) after catheter ablation of AF. Methods We retrospectively analyzed 1,853 participants (73.1% men, mean age 63.3±10.3 years, 60.7% paroxysmal AF) who received first catheter ablation of AF with pre-ablation plasma BNP level measurement and completed follow-up more than 3 months after the procedure from AF Frontier Ablation Registry, a multicenter cohort study in Japan. We evaluated an association between plasma BNP level before catheter ablation and first MACCE in cox-regression hazard models adjusted for known risk factors. MACCE were defined as stroke/transient ischemic attack (TIA), cardiovascular events or all-cause death. Results The mean plasma BNP level was 120.2±3.7 pg/mL. During a mean follow-up period of 21.9 months, 57 patients (3.1%) suffered MACCE (ischemic stroke 8 [14.0%], hemorrhagic stroke 5 [8.8%], TIA 5 [8.8%], hospitalization for heart failure 11 [19.2%], acute coronary syndrome 9 [15.8%], hospitalization for other cardiovascular events 8 [14.0%] and all-cause death 11 [19.2%]). Plasma BNP level of patients with MACCE were significantly higher than those without MACCE (291.7±47.0 vs 114.7±3.42 pg/mL, P&lt;0.001). Multivariate analysis revealed that plasma BNP level (hazard ratio [HR] per 10 pg/mL increase 1.014; 95% confidence interval [CI] 1.005–1.023; P=0.001), baseline age (HR 1.052; 95% CI 1.022–1.084; P=0.001), heart failure (HR 2.698; 95% CI 1.512–4.815; P=0.001), old myocardial infarction (HR 3.593; 95% CI 1.675–7.708; P=0.001) and non-ischemic cardiomyopathy (HR 2.676; 95% CI 1.337 - 5.355; P=0.005) were independently associated with MACCE. At receiver-operating characteristic curve analysis, plasma BNP level before catheter ablation ≥162.7 pg/mL was the best threshold to predict MACCE (area under the curve: 0.71). Kaplan-Meier curve analysis (Figure) showed that the cumulative incidence of MACCE was significantly higher in patients with a BNP ≥162.7 pg/mL than in those with a BNP below 162.7 pg/mL (HR 4.85; 95% CI 2.86–8.21; P&lt;0.001). Conclusions Elevation of plasma BNP level was independently related to the increased risk of MACCE after catheter ablation ofAF. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bristol-Meiers Squibb

scholarly journals Atrial fibrillation recurrence after transcatheter ablation worsens left atrial strain

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Annunziata ◽  
F Notaristefano ◽  
L Spighi ◽  
S Piraccini ◽  
G Giuffre' ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Atrial Strain ◽  
Af Recurrence

Abstract Introduction Left atrial strain (LAs) shows correlation with atrial fibrosis and is a predictor of atrial fibrillation (AF) recurrence after transcatheter ablation. Little is known about LAs evolution after ablation. Purpose We sought to evaluate the atrial function with echocardiographic strain before and 6 months after AF ablation. Methods 65 consecutive patients undergoing radiofrequency or cryoballoon ablation for atrial fibrillation at our centre were enrolled. They underwent a transthoracic echocardiography before the procedure and at 6 months follow-up. 5 patients were excluded because of low quality images. Global left atrial strain during the reservoir phase (LASr) was calculated as a mean of the values obtained in 4 and 2 chamber apical view; the ventricular end-diastole was set as reference to allow the calculation both in patients in AF and sinus rhythm during the echocardiography. Recurrence was defined as any atrial arrhythmia episode lasting more than 30 seconds recorded on an EKG strip after the 3 months blanking period; all patients underwent a 24 hours EKG Holter after the blanking period to detect asymptomatic recurrence. Quality of life was assessed before the procedure and at follow-up with the EQ-5D-3L model. Results At 6 months 14 patients (13%) had AF recurrence. Patients with recurrence (AF-R) had similar baseline characteristics compared to those without recurrence (AF-NR) but the former had a longer history of AF (39±53 vs 85±94 months, p=0,018). LASr, LA volume and left ventricle ejection fraction (EF) were similar at baseline between groups. At follow-up LASr was significantly impaired in the AF-R group compared to AF-NR (14±6% vs 26±10% respectively, p&lt;0,0001) whereas LA volume, LV end systolic volume and EF remained similar. Compared to baseline LASr worsened in patients experiencing AF recurrence (22±11% vs 14±6%, p=0.016) and this finding was consistent also in patients in sinus rhythm during both examinations (29±8 vs 17±7, p=0,005). Compared to baseline LASr (22±10% vs 26±10%, p=0.024), LV end-systolic volume (29±15 ml vs 22±6 ml, p=0,006) and EF (51±9% vs 58±18%, p=0,038) improved in the AF-NR group but the effect was driven mainly by patients restoring sinus rhythm. Both groups showed a significant improvement of the quality of life (55±23 vs 85±13, p&lt;0,0001 AF-NR; 63±17 vs 80±12, p=0,012 AF-R). Conclusions Atrial fibrillation recurrence after transcatheter ablation is associated with significant left atrial strain worsening which indicates disease progression and may predispose to further long-term recurrences whereas a successful ablation has a protective effect on atrial function. Funding Acknowledgement Type of funding source: None

P1485Left atrial reservoir function is associated with major adverse cardiac events in patients undergoing transarterial valve implantation for isolated severe aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Weber ◽  
F Petillo ◽  
S Pollack ◽  
G Petrossian ◽  
N Robinson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Independent Predictor ◽  
Global Longitudinal Strain ◽  
Free Wall ◽  
Valve Implantation

Abstract Background Left atrial (LA) reservoir function as measured by LA global longitudinal strain (LAGS) is an independent predictor of left ventricular (LV) performance and has prognostic value. Purpose To evaluate by speckle tracking echocardiography (STE), LAGS and other myocardial deformation indices changes after transarterial valve implantation (TAVI) for severe isolated aortic stenosis (AS) in relation to the outcome measures. Methods Of 995 pts who underwent TAVI at our Institution between 2017–18, 120 (age = 82.8±7.7 years, 74% female, AVAi = 0.37±0.09 cm2/m2, LVEF = 61.6±11.3%, no > than 2+ mitral or aortic regurgitation, all in NSR) underwent 2-D echocardiography and STE, pre (21±34 days) and post (16±27 days) TAVI. LAGS was measured at QRS onset, and LV global longitudinal strain (LVGS) and RV free wall strain were recorded. The velocity index = peak vel LVOT/AV. Phillips IE 33 scanners (frame rates 60–80 Hz) were used and one observer analyzed data on QLAB software. The median follow-up was 208 days (range 20–763). The outcome variable was a composite of death, atrial fibrillation and hospitalization for heart failure (MACE). Univariate and multivariable logistic regression were used to determine independent predictors of LA, LV and RV free wall global strain changes (covariates; age, sex, BSA, LVEF, systolic blood pressure, LA volume index) and, separately, for predictors of MACE (covariates; age, sex, AVA index, LVEF and E/e'). Intra- and interclass correlation coefficients (ICC) were calculated. Results The intra- and inter-observer ICC was 0.70–0.90 and 0.90–0.95, respectively. In the absence of LA volume change, LAGS improved post TAVI in 54% of pts. Overall, mean change was 2.2±11.6% (95% CI; 0.05, 4.3) and it was significantly associated in multivariable analysis with RV free wall strain (OR=2.7, 95% CI; 1.2, 6), velocity index (OR=0.4, 95% CI; 0.2, 1), LVEF (OR= 0.3, 95% CI; 0.2, 0.8) and LVGS (OR=3.8, 95% CI; 1.4, 10), yielding together an AUC of 0.90. LVGS improved in 64% of pts by −2.8±7.5%, (95% CI: −4.2, −1.5) and the velocity index independently predicted the LVGS change (OR = 0.6; 95% CI: 0.4, 0.9). The other deformation indices did not significantly change. At follow-up, there were 6 hospitalizations for heart failure, 5 atrial fibrillation events and 6 deaths. At multivariable logistic regression analysis, post TAVI LAGS was the only variable independently predicting MACE (OR (in units of 1%) = 0.90, 95% CI; 0.82, 0.98), estimating that a 1% increase in post-LAGS decreases the likelihood of MACE by 10%. Conclusions 1. There was no relationship between LA systolic volume and LAGS change after TAVI. 2. Within a month after the procedure, LAGS improves in less than half of pts and is directly associated with both ventricles systolic function and AS severity. 3. At a median of 9 months after TAVI, post procedural LAGS is an independent predictor of MACE and could be used in the risk stratification of such pts.

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Brian D McCauley ◽  
Esseim Sharma ◽  
John Dudley ◽  
Antony Chu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Prospective Trials

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

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