Left atrial function after successful catheter ablation for paroxysmal atrial fibrillation: cryoablation versus radiofrequency techniques

Abstract Funding Acknowledgements Type of funding sources: None. Purpose It has been suggested that cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency (RF) ablation, however, results are conflicting. We sought to address this issue using modern echocardiographic techniques. Methods We performed transthoracic echocardiography in 90 patients (66% males, mean age 57 ± 10 years) successfully treated with RF (51%) or CB (49%) ablation for PAF before and 6 months after the procedure. Peak longitudinal LA strain (LAS) and strain rate (LASR) during the reservoir (r), conduit (cd) and contraction (ct) phases were measured during sinus rhythm by speckle tracking. The LA diameter and volume (LAV) index - using biplane area-length method divided by the body surface area were also calculated. Results The LA diameter decreased (38.1 ± 4.0 vs 37.2 ± 3.8 mm, p = 0.004), the LAV index did not change (33.5 ± 11.9 vs 34.4 ± 8.9 mL/m², p = 0.272) at 6 months in the whole study group. The LASRr and LASRcd increased, whereas there were no changes in remaining LA function parameters in either ablation strategy (table). The CB subgroup did not differ in LA function parameters comparing to RF subgroup at six months after procedure (table). Conclusion CB and RF ablation did not differentially affect the LA function. Successful ablation for PAF resulted in improvement of rate of deformation during reservoir and conduit LA cycle and stable contractile LA function. LA function parameters RF N = 46 (51%) CB N = 44 (49%) 6 months RF vs CB Parameter Baseline 6 months p Baseline 6 months p p* Global LASr [%] 27.7 ± 6.35 27.9 ± 6.0 0.833 27.9 ± 7.2 27.0 ± 6.4 0.370 0.539 Global LAScd [%] -14.6 ± 4.1 -14.8 ± 4.6 0.761 -15.3 ± 5.3 -14.1 ± 3.2 0.080 0.399 Global LASct [%] -13.0 ± 4.84 -13.0 ± 3.20 1.00 -12.6 ± 3.81 -12.9 ± 4.18 0.629 0.897 Global LASRr [sˉ¹] 1.18 ± 0.22 1.27 ± 0.26 0.046 1.07 ± 0.27 1.18 ± 0.30 0.041 0.141 Global LASRcd [sˉ¹] -1.11 ± 0.33 -1.25 ± 0.35 0.013 -1.07 ± 0.31 -1.16 ± 0.30 0.044 0.214 Global LASRct [sˉ¹] -1.46 ± 0.40 -1.50 ± 0.31 0.500 -1.42 ± 0.51 -1.39 ± 0.42 0.742 0.187 *p value corrected for baseline values

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Use of speckle-tracking echocardiography to stratify risk of atrial fibrillation-related stroke: comparison of left atrial and atrial appendage mechanics

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.088 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Mao ◽

Y Yang ◽

C Yu ◽

MM Ma ◽

YH Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Speckle Tracking ◽

Univariate Analysis ◽

Diagnostic Value ◽

P Value ◽

Analysis Model ◽

Time To Peak ◽

Funding Sources ◽

Increased Risk

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the National Natural Science Foundation of China onbehalf Sir Run Run Shaw Hospital,Zhejiang University,School of Medicine Background Left atrial (LA) and appendage (LAA) dysfunction were associated with increased risk of stroke in atrial fibrillation. However, usefulness of LA and LAA mechanics has not been fully compared. Methods:201 AF patients were prospectively enrolled. 42(20.8%) had previous stroke/TIA. Speckle tracking was used to measure LA and LAA peak postive strain. LA and LAA MD was defined as the SD of time to peak positive strain corrected by the R-R interval. Results:LA MD and LAA MD were independently associated with stroke/TIA. The model based on CHA2DS2-VASc score for discrimination of stroke was significantly improved by adding LA MD or LAA MD (P < 0.01). Diagnostic value of LA MD was better than LAA MD in patients with normal LA volumes, while LAA MD was more useful in patients with LA enlargement.Conclusion:Both LA and LAA mechanics had incremental value over CHA2DS2VASc score. However, priorities of strain assessment depend on patients’ LA volume. Variables Univariate analysis Multivariate analysis Model 1 Model 2 Model 3 OR (95% CI) P value OR (95% CI) P value OR (95% CI) p value OR (95% CI) P value Clinical parameters Age 1.09(1.04-1.14) <0.001 1.11(1.04-1.17) 0.001 1.11(1.05-1.17) 0.001 1.11(1.04-1.17) 0.001 BMI 0.988(0.89-1.10) 0.84 1.07(0.92-1.25) 0.40 1.07(0.91-1.25) 0.40 CHA2DS2-VASc score 1.52(1.15-2.00) 0.003 1.08(0.67-1.74) 0.76 1.08(0.65-1.80) 0.77 1.10(0.69-1.76) 0.69 Persistent AF 1.88(0.94-3.74) 0.07 0.75(0.23-2.40) 0.63 0.87(0.27-2.81) 0.82 Therapeutic anticoagulation 0.56(0.28-1.11) 0.10 0.22(0.09-0.57) 0.002 0.23(0.09-0.59) 0.002 0.22(0.09-0.57) 0.002 LA parameters LAEF 0.96(0.94-0.99) 0.002 0.982(0.953-1.01) 0.26 iLAVmin 1.03(1.01-1.05) 0.006 0.98(0.94-1.02) 0.27 LA MD 1.22(1.10-1.36) <0.001 1.16(1.02-1.32) 0.02 1.18(1.03-1.34) 0.02 1.16(1.02-1.32) 0.02 LA GLS 0.935(0.893-0.98) 0.005 1.0(0.953-1.14) 0.36 1.02(0.94-1.12) 0.59 1.02(0.94-1.10) 0.72 LAA parameters LAAEV 0.12(0.02-0.74) 0.02 3.34(0.31-36.06) 0.32 LAA EF 0.98(0.96-1.00) 0.06 1.01(0.98-1.04) 0.65 LAA GLS 0.85(0.77-0.94) 0.001 0.96(0.86-1.07) 0.46 0.97(0.87-1.08) 0.59 0.96(0.87-1.06) 0.44 LAA dense SEC/thrombus 3.12(1.39-6.99) 0.006 2.02(0.75-5.45) 0.167 LAA MD 1.19(1.09-1.29) <0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 Univariable and multivariable logistic regression analyses of associations between clinical and echocardiographic covariates with stroke Abstract Figure.

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Predictors of atrial fibrillation in patients with cryptogenic stroke and fifteen-days electrocardiographic monitoring. Preliminary results of the DECRYPTORING study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.121 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Vera Sainz ◽

A Cecconi ◽

P Martinez Vives ◽

A Ximenez Carrillo ◽

C Aguirre ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Retrospective Studies ◽

Cryptogenic Stroke ◽

P Value ◽

Ecg Monitoring ◽

Funding Sources ◽

Electrocardiographic Monitoring ◽

3D Volume ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf DECRYPTORING study Introduction Cryptogenic stroke (CS) represents up to 30% of all stroke types. In one third of CS, atrial fibrillation (AF) is identified as the underlying cause. Predictors of AF in the setting of CS have been described, however these findings were based on retrospective studies and with maximum ECG monitoring of 72 hours. To overcome these limitations, we designed the prospective Decryptoring study whose objective is to create a comprehensive predictive model for AF in patients with CS. Methods From April 2019, 41 consecutive patients with a CS and age > 60 years were included. On admission, a transthoracic echocardiogram with 3D volume and left atrial (LA) strain was performed. All patients were monitored with a 15-day ECG-Holter after discharge. Patients were classified according to AF detection. Results AF was detected in 9 patients (22%). Patients with AF were older (75.9 ± 8 vs. 81.9 ± 4.3 years, p = 0.041). There was no difference in T-troponin levels. NTproBNP was higher in the group with AF (350 ± 586 pg / ml vs. 1084 ± 1416 pg / ml, p = 0.018). Regarding LA strain, patients with AF presented reservoir LA strain (25.5 ± 8.2% vs 17.4 ± 4.3%; p = 0.006) and conduct LA strain (12 ± 5.2% vs 7.2 ± 1.5%; p = 0.01) lower than patients without AF. There were no differences in contraction LA strain or other echocardiographic variables. The risk of developing AF was higher in patients with NTproBNP> 165 pg / ml (OR 11.3 [95% CI 1.2-102.9] p = 0.031), LA reservoir strain <19.1% (OR 7.7 [IC 95 % 1.5-40.0] p = 0.016) and LA conduct strain <9.1% (OR 7.8 [95% CI 1.3-45.0] p = 0.022) (Table). Conclusions This prospective study, demonstrates that high NTproBNP, low reservoir LA strain and low conduct LA strain are associated with underlying AF in patients with cryptogenic stroke. No AF (n = 32) AF (n = 9) P value Age (years) 75.9 ± 8 81.9 ± 4.3 p = 0.041 NTPROBNP (pg/ml) 350 ± 586 1084 ± 1416 P = 0.018 LA indexed diastolic volume (ml/m2) 30 ± 11.8 33.8 ± 9.8 P = 0.35 LA EF (%) 45 ± 16.7 45 ± 12.8 P = 1 Reservoir LA strain (%) 25.5± 8.2 17.4± 4.3 P = 0.006 Conduct LA strain (%) 12 ± 5.2 7.2 ± 1.5 P = 0.01 Contraction LA strain (%) 13.5 ±5.3 10.2± 3.9 P = 0.10 NTPROBNP > 165 pg/ml 12 (41%) 8 (89%) OR 11.3 [IC 95% 1.2-102.9]; p = 0.031 Reservoir LA strain <19.1% 6 (20%) 6 (67%) OR 7.7 [IC 95% 1.5-40.0]; p = 0.016 Conduct LA strain <9.1% 9 (31%) 7 (78%) OR 7.8 [IC 95% 1.3-45.1]; p = 0.022

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Prevalence of paroxysmal atrial fibrillation in patients with cerebrovascular stroke of undetermined etiology

QJM ◽

10.1093/qjmed/hcab090.026 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed Elnwagy ◽

Hossam Shokery ◽

Emad Effat ◽

Hayam El Damnhory

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Cryptogenic Stroke ◽

Holter Monitoring ◽

Ectopic Beat ◽

Unknown Etiology ◽

P Value ◽

Undetermined Etiology ◽

Cerebrovascular Stroke

Abstract Background cerebrovascular stroke is major cause of morbidity and disability. Many causes may contribute to its presence, however. Some patients have none of the identified risk factors, yet face the consequences of stroke or transit ischemic attack. This type of stroke known to be stroke of undetermined source or etiology. It has a high rate of recurrence due to the persistence of the unknown etiology. Paroxysmal atrial fibrillation remains the hidden bottom of an iceberg representing a major part of the causes of ischemic cerebrovascular stroke of undetermined etiology . Aim and Objectives: to determine the prevalence of subclinical atrial fibrillation in patients with ischemic cerebrovascular stroke of undetermined etiology in a population in Egypt by 48h holter monitoring. Patients and Methods Patients diagnosed with acute cerebrovascular stroke of undetermined etiology at the neurology department of Ain Shams university hospitals underwent 48 hours holter monitoring within the first week of the insulting event. Results This study included 50 patients with cryptogenic stroke (CS) who underwent 48 hours holter monitoring. The patients' ages ranged between 22 and 77 years old (mean age 48.46 ± 12.74years). This study included 34 males and 16 females. Their body mass index BMI ranges from 21-35 kg/m2, with mean BMI of 24.78 ± 2.99 kg/m2. Their left atrial diameter ranges from 26-47mm, with mean diameter of 36.08 ± 5.23mm .Eight out of fifty patients newly diagnosed with subclinical atrial fibrillation with prevalence of 16%. There was statistically significant association between the atrial fibrillation (AF) and both age (p value, 009) and left atrial (LA) diameter (p value, 001) .There was an associated finding that need further investigation about the significant association between the ventricular ectopic beat VEB burden and the presence of AF or stroke. Conclusion The prevalence of paroxysmal atrial fibrillation among the population of ischemic stroke of undetermined etiology in a population in Egypt is close to worldwide percentage and the recent met analysis studies of 11%.

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