scholarly journals Left atrial size derived by non-contrast cardiac computed tomography and risk of incident atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.H Fredgart ◽  
J.S Lindholt ◽  
A Brandes ◽  
F.H Steffensen ◽  
L Frost ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cardiac Computed Tomography ◽  
Pulmonary Veins ◽  
Population Based ◽  
Individual Risk ◽  
Funding Source ◽  
Screening Trial

Abstract Introduction Left atrial (LA) size is an independent predictor of cardiovascular outcome. While performing non-contrast computed tomography (NCCT), LA size is readily available, and a single cross-section area provides a accurate estimate of LA enlargement. Purpose The purpose of this study was to examine if enlarged LA measured by a NCCT scan was an independent risk factor of subsequent atrial fibrillation or flutter (AF). Methods The Cardiovascular Screening Trial; a population-based multicenter randomized screening trial, consisting primarily of men aged 60–74 years were randomly allocated (1:2) for screening. NCCT was performed and LA area was manually traced in a single axial slice excluding the pulmonary veins at mitral valve level. LA size was indexed to body surface area. Indexed LA area was divided into five categories (defined by standard deviations). Hospital admission due to AF were identified using data from the National Patient Registry using ICD-10 codes (DI48-DI489). Results Between 2014 and 2019, 14,986 participants were enrolled, of these 13,410 without known AF were eligible for follow-up. During 2.3±1.0 years of follow-up 301 developed incident AF, corresponding to an incidence rate of 10.0 per 1,000 person-years. Figure 1 shows the Kaplan-Meier of incident AF stratified by categories of LA (p<0.0001). A very large LA was associated with a four-fold higher risk of incident AF in the fully adjusted analysis (HR (95% CI): 4.0 (2.6–5.8), p<0.0001), and a two-fold higher risk by a large LA (HR (95% CI): 2.0 (1.5–2.6), p<0.0001) (Table 1). Conclusion An enlarged LA area measured by NCCT was associated with a two to four-fold higher risk of incident AF. The prognostic use of LA area provides an individual risk assessment during NCCT for other purposes. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by the University of Southern Denmark and the Region of Southern Denmark.

scholarly journals Comparison of transthoracic echocardiography with computed tomography in evaluation of pulmonary veins

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Qing-Qing Dong ◽  
Wen-Yi Yang ◽  
Ya-Ping Sun ◽  
Qian Zhang ◽  
Guang Chu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Transthoracic Echocardiography ◽  
Anatomic Variation ◽  
Cardiac Computed Tomography ◽  
Pulmonary Veins ◽  
Non Invasive ◽  
Clear Identification ◽  
The Right

Abstract Background Transesophageal echocardiography may be used to assess pulmonary veins for atrial fibrillation ablation. No study focused on the role of transthoracic echocardiography (TTE) in evaluating the diameter and anatomy of pulmonary veins. Methods Among 142 atrial fibrillation patients (57.7% men; mean age, 60.5) hospitalised for catheter ablation, we assessed pulmonary veins and compared the measurements by TTE with cardiac computed tomography (CT) before ablation. Among 17 patients who had follow-up examinations, the second measurements were also studied. Results TTE identified and determined the diameters of 140 (98.6%) right and 140 (98.6%) left superior PVs, and 136 (95.7%) right and 135 (95.1%) left inferior PVs. A separate middle PV ostia was identified in 14 out of the 22 patients (63.6%) for the right side and in 2 out of 4 (50.0%) for the left side. The PV diameters before ablation assessed by CT vs. TTE were 17.96 vs. 18.07 mm for right superior, 15.92 vs. 15.51 mm for right inferior, 18.54 vs. 18.42 mm for left superior, and 15.56 vs. 15.45 mm for left inferior vein. The paired differences between the assessments of CT and TTE were not significant (P ≥ 0.31) except for the right inferior vein with a CT-minus-TTE difference of 0.41 mm (P = 0.018). The follow-up PV diameters by both CT (P ≥ 0.069) and TTE (P ≥ 0.093) were not different from baseline measurements in the 17 patients who had follow-up measurements. Conclusions With a better understanding of PV anatomy in TTE imaging, assessing PV diameters by non-invasive TTE is feasible. However, the clear identification of anatomic variation might still be challenging.

scholarly journals A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Author(s):  
Jun Ding ◽  
Jing Xu ◽  
Wei Ma ◽  
Bingwei Chen ◽  
Peigen Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Dwell Time ◽  
Pulmonary Veins ◽  
Group Versus ◽  
Conventional Group ◽  
Optimal Dosage ◽  
Total Procedure Time ◽  
The Mean

Abstract Background : The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods: A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 seconds each)(the Cryo-AF Conventional group n=84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of -40°C within 60 seconds (the Cryo-AF Dosing group n=80). Results: We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7±0.8, with no difference between groups (Cryo-AF Conventional , 8.7±0.8 versus Cryo-AF Dosing ,8.6±0.8; P =0.359). The Cryo-AF Dosing group required significantly less total cryotherapy application time (990.60±137.77versus 1501.58±89.60 seconds; P <0.001) and left atrial dwell time (69.91±6.91 versus 86.48±7.03 minutes; P <0.001) than the Cryo-AF Conventional group. Additionally, the Cryo-AF Dosing group required significantly less total procedure time (95.03±6.50 versus 112.43±7.11 minutes; P <0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 minutes. The reconnection rates between the Cryo-AF Conventional and Cryo-AF Dosing groups were similar in that 2.98% and 0.94% of the initially isolated veins were reconnected, respectively, ( P =0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AF Dosing group versus 78.57% in the Cryo-AF Conventional group ( P =0.978). Conclusion: A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

scholarly journals Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement

2020 ◽  
Vol 47 (2) ◽  
pp. 78-85
Author(s):  
Kazuhiro Osawa ◽  
Rine Nakanishi ◽  
Indre Ceponiene ◽  
Negin Nezarat ◽  
William J. French ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Left Atrial Volume ◽  
Atrial Appendage ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Appendage Thrombus

Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03–1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05–1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.

scholarly journals The Role of Magnetic Resonance Imaging and Cardiac Computed Tomography in the Assessment of Left Atrial Anatomy, Size, and Function

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Petr Kuchynka ◽  
Jana Podzimkova ◽  
Martin Masek ◽  
Lukas Lambert ◽  
Vladimir Cerny ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Cardiac Computed Tomography ◽  
Left Atrial Volume ◽  
Detailed Knowledge ◽  
Long Term Outcome ◽  
And Function

In the last decade, there has been increasing evidence that comprehensive evaluation of the left atrium is of utmost importance. Numerous studies have clearly demonstrated the prognostic value of left atrial volume for long-term outcome. Furthermore, advances in catheter ablation procedures used for the treatment of drug-refractory atrial fibrillation require the need for detailed knowledge of left atrial and pulmonary venous morphology as well of atrial wall characteristics. This review article discusses the role of cardiac magnetic resonance and computed tomography in assessment of left atrial size, its normal and abnormal morphology, and function. Special interest is paid to the utility of these rapidly involving noninvasive imaging methods before and after atrial fibrillation ablation.

Long-term implications of left atrial appendage thrombus identified incidentally by pre-procedural cardiac computed tomography angiography in patients undergoing transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Yishay Szekely ◽  
Haim Shmilovich ◽  
Aviram Hochstadt ◽  
Eihab Ghantous ◽  
Yan Topilsky ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Cardiac Computed Tomography Angiography ◽  
Late Mortality ◽  
Transcatheter Aortic Valve

Abstract Aims The prevalence and prognostic implications of left atrial appendage (LAA) thrombus (LAAT) in patients considered for transcatheter aortic valve replacement (TAVR) are incompletely defined. We, therefore, studied pre-procedural cardiac computed tomography angiography (CCTA) scans of TAVR candidates to determine the prevalence of LAAT and its association with late outcomes. Methods and results Baseline clinical variables and CCTA findings from a prospective TAVR registry were analysed for the prevalence of pre-procedural LAAT and its impact on in-hospital outcomes and late mortality. LAAT was differentiated from LAA filling defects (LAAFD) reflecting stasis without clot. Patients (n = 561) with complete in-hospital and late mortality data were included in the study (median follow-up 31.6 months). LAAT and LAAFD were evidenced on pre-procedural CCTA in 24 (4.3%) and 26 (4.6%) patients, respectively. One hundred fourteen (20.3%) patients died during the study period. Though in-hospital adverse event rates (including stroke) did not differ among groups, mortality at long-term follow-up was higher among LAAT patients compared with those with or without LAAFD (58.3% vs. 11.5% vs. 19.0%, respectively; P &lt; 0.003). By multivariable analysis, LAAT (but not LAAFD) was independently associated with all-cause mortality [hazard ratio (HR) = 3.33 (1.83–6.00), P &lt; 0.001]. In patients with LAAT, oral anticoagulation at discharge was associated with lower mortality risk, independently of atrial fibrillation status. Conclusions LAAT visualized by pre-procedural CCTA is an independent predictor of late mortality following TAVR, but not peri-procedural stroke. When reporting TAVR-CCTA, particular note should be made of LAA features and presence of LAAT which may have prognostic and management implications.

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