scholarly journals P318 Left atrial dysfunction assessed by echocardiography in relation to left atrial fibrosis in patients undergoing ablation for atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Pilichowska ◽  
J Baran ◽  
P Kulakowski ◽  
B Zaborska
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Systolic Function ◽  
Electrophysiological Study ◽  
Stiffness Index ◽  
P Value ◽  
Group 2 ◽  
Left Atrial Dysfunction ◽  
Left Atrial Fibrosis ◽  
Group 1

Abstract PURPOSE Left atrial (LA) fibrosis is the hallmark of LA remodeling in atrial fibrillation (AF), alters LA function and may predict poor catheter ablation (CA) outcome. LA fibrosis may be assessed invasively using electroanatomical mapping (EAM) during electrophysiological study. The aim was to assess LA function parameters in relation to degree of LA fibrosis derived from EAM in patients with AF. METHODS Patients (pts) n = 39 (79% males, mean age 56+/-10) with non-valvular AF were studied with TTE and TEE before first CA during sinus rhythm. LA strain (LAS) and strain rate (LASR) were analyzed in reservoir (r), conduit (cd) and contractile (ct) phases. The velocities of mitral A, E" and A" were measured with Doppler. E/E" and LA stiffness index - the ratio of E/E" to LASr were assessed. LA appendage flow velocity (LAAv) was measured in TEE. LA volume using biplane area-length method was calculated. The EAM of LA was build using Carto System before CA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut-off <0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA <10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA >40%) (table). RESULTS The mean LA volume was 35 ± 11 mL/m². The LAPA ranged from 2 to 78 % of LA surface. Reduced LA function was observed in the LAPA >40% group. Extensive LAPA altered mainly LA compliance parameters. Traditional LA systolic function parameters did not differ in relation to degree of LAPA. CONCLUSION LA compliance is mostly affected by LA fibrosis, thus LA diastolic parameters may be useful in the noninvasive assessment of LA fibrosis. Whether these parameters should be a part of the proper selection of candidates for CA requires further studies. LA function parameters LA parameters Group 1 LAPA <10% n = 13 Group 2 LAPA >10% <40% n = 13 Group 3 LAPA >40% n = 13 P-value Group 1 + 2 vs 3 Mitral A 0.55 ± 0.10 0.55 ± 0.24 0.73 ± 0.32 0.077 A" 9.19 ± 1.74 7.85 ± 1.43 7.92 ± 2.40 0.376 LASr 31.48 ± 4.52 26.48 ± 8.79 19.63 ± 6.76 <0.001 LAScd 17.30 ± 3.05 15.44 ± 6.93 10.91 ± 4.04 0.003 LASct 14.18 ± 5.36 11.05 ± 3.67 8.72 ± 4.78 0.024 LASRr 1.22 ± 0.19 1.24 ± 0.21 0.92 ± 0.20 <0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 <0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 <0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178

scholarly journals The Association of Pre-Existing Left Atrial Fibrosis with Clinical Variables in Patients Referred for Catheter Ablation of Atrial Fibrillation

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15036 ◽  
Author(s):  
Jane Dewire ◽  
Irfan M. Khurram ◽  
Farhad Pashakhanloo ◽  
David Spragg ◽  
Joseph E. Marine ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Af Ablation ◽  
Group 4 ◽  
Significant Difference ◽  
History Of ◽  
Group 2 ◽  
Magnetic Resonance Imaging Mri ◽  
Left Atrial Fibrosis

Introduction Atrial fibrillation (AF) recurrence after ablation is associated with left atrial (LA) fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI). We sought to determine pre-ablation, clinical characteristics that associate with the extent of LA fibrosis in patients undergoing catheter ablation for AF. Methods and Results Consecutive patients presenting for catheter ablation of AF were enrolled and underwent LGE-MRI prior to initial AF ablation. The extent of fibrosis as a percentage of total LA myocardium was calculated in all patients prior to ablation. The cohort was divided into quartiles based on the percentage of fibrosis. Of 60 patients enrolled in the cohort, 13 had <5% fibrosis (Group 1), 15 had 5-7% fibrosis (Group 2), 17 had 8-13% fibrosis (Group 3), and 15 had 14-36% fibrosis (Group 4). The extent of LA fibrosis was positively associated with time in continuous AF, and the presence of persistent or longstanding persistent AF. However, no statistically significant difference was observed in the presence of comorbid conditions, age, BMI, LA volume, or family history of AF among the four groups. After adjusting for diabetes and hypertension in a multivariable linear regression model, paroxysmal AF remained independently and negatively associated with the extent of fibrosis (-4.0 ± 1.8, P = 0.034). Conclusion The extent of LA fibrosis in patients undergoing AF ablation is associated with AF type and time in continuous AF. Our results suggest that the presence and duration of AF are primary determinants of increased atrial LGE.

P426Routine use of transoesophageal echocardiography in patients with atrial fibrillation or atrial flutter undergoing cardioversion

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Etsadashvili ◽  
N Kuridze ◽  
T Kavtiashvili ◽  
T S Chaligava ◽  
V Chumburidze
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Anticoagulation Therapy ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Cardiac Thrombus ◽  
Group 2 ◽  
Anticoagulated Patients ◽  
Group 1

Abstract Background. According to the recent guidelines, effective anticoagulation is recommended for a minimum of 3 weeks before the cardioversion of Atrial Fibrillation/Atrial Flutter. Transoesophageal echocardiography (TOE) could be considered, but is not mandatory to exclude/confirm the cardiac thrombus before the cardioversion in adequately anticoagulated patients. Aim of the study was to reveal the incidence of thrombus or spontaneous echo contrasting (SEC) by TOE before cardioversion, despite effective anticoagulation. Material and methods. Patients, where TOE was performed to evaluate the evidence of thrombus/SEC before the cardioversion of AF/Atrial flutter at our clinic in period of 2016-2018, were studied. Incidence of intracardiac thrombus and its relation to patients’ gender, age, hypertension, diabetes, atrial diameter, LVEF, duration of Atrial Fibrillation/Atrial flutter, as well as to anticoagulation regimen were evaluated. Results. All patients received recommended anticoagulation therapy, DOACs or VKAs, for a minimum of 3 weeks before the TOE. Finally 180 patients were divided in two groups: group 1 (121 patients) without evidence of thrombus and group 2 (59 patients) where TOE revealed the thrombus. Thrombus was found in 37 (20.5%) patients, and SEC was found in 22 (12.2%) patients. There were no difference between the two groups with respect to: gender (85 male (70%) in group 1 vs. 38 male (64%) in group 2, p = NS), age (62.8 ± 8.73 vs. 63.0 ± 9.04, p = NS), hypertension (78 (64.4%) vs. 44 (74.6%), p = NS), diabetes (17 (14%) vs. 7 (12%), p = NS), CHAD2DS2-VASc score (2.2 ± 1.8 vs. 2.4 ± 4.0, p = NS), LVEF (48.1 ± 7.1% vs. 46.4 ± 7.3%, p = NS), duration of arrhythmia (7.7 ± 11.6 months vs. 9.7 ± 14.0 months, p = NS), type on anticoagulation (DOACs 59 (48.3%) vs. 30 (50.8%), p = NS, VKA (Warfarin) 54 (44.6%) vs. 29 (49.1%), p = NS)) respectively. Only difference in atrial diameter was found statistically significant between the two groups: left atrial diameter (42.6 ± 3.3mm vs. 45.3 ± 3.6mm, p &lt; 0.001) and right atrial diameter (39.4 ± 3.3mm vs. 40.8 ± 2.3mm, p = 0.001) respectively. Conclusion. Thrombus/SEC could persist despite the effective anticoagulation therapy for ≥3 weeks. Therefore all patients should perform TOE before the cardioversion to avoid the incidence of stroke.

P6580Prevalence and clinical significance of latent Brugada syndrome in juvenile lone atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Fathy ◽  
L Gaido ◽  
S Quaranta ◽  
M Anselmino ◽  
C Giustetto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Family History ◽  
Clinical Characteristics ◽  
Young Patients ◽  
P Value ◽  
Lone Atrial Fibrillation ◽  
History Of ◽  
Group 2 ◽  
Group 1

Abstract Introduction Brugada syndrome (BrS) cause about 20% of sudden cardiac death (SCD) in young healthy adults. Nearly 20% of Brugada patients develop supraventricular arrhythmias, mostly atrial fibrillation (AF). But whether lone AF may be the first clinical manifestation in young patients with latent BrS remains unclear. Purpose To estimate the prevalence and clinical significance of latent Brugada ECG pattern in young population (age ≤45 years) with lone AF. Methods A total of 78 patients with lone atrial fibrillation (mean age 35±7) were selected from 111 young patients with juvenile atrial fibrillation (age ≤45 years) between January 2015 and November 2017. All patients were clinically evaluated. Moreover 12 lead-24H Holter ECG and pharmacological class 1C antiarrhythmic drug (AAD) test were done for high suspicious cases of Brugada ECG. The diagnosis of Brugada ECG pattern was established according to the second consensus report criteria 2005 and since 2013, according to HRS/EHRA/APHRS expert consensus statement. Results According to the study protocol, we considered two groups of patients, group 1: 13 patients (16.7%; mean age 37±8) were diagnosed with type 1 Brugada ECG pattern (3 during class 1C AADs therapy and 10 induced by class 1C AAD test), group 2: 65 patients (83%; mean age 35±7) diagnosed as lone AF without type 1 Brugada ECG. The clinical characteristics of the two groups are described in table 1. Regarding to group 1, two patients had positive electrophysiological study with subsequent ICD implantation and genetic test for SCN5A mutation was positive in 3 patients. Table 1. G1, G2 clinical characteristics Patients characteristics Group 1 (n=13) Group 2 (n=65) P value Mean age (years) 37±8 35±7 0.42 Gender (Male %) 7 (54%) 54 (83%) 0.02 Family history of BrS 2 (15%) 0 (0%) 0.03 Family history of SCD 1 (8%) 1 (1.5%) 0.20 Syncope 4 (31%) 5 (8%) 0.02 Sick Sinus Syndrome 1 (8%) 7 (11%) 0.70 Paroxysmal AF 12 (92%) 54 (83%) 0.40 Suspected basal ECG for BrS 13 (100%) 28 (43%) <0.01 Statistical test is considered significant when p value <0.05. Conclusions Up to our knowledge this study is the first one that estimate the prevalence of latent BrS in juvenile lone AF patients. Young patients with lone AF had a high prevalence of latent BrS. Syncope, family history of SCD and family history of BrS are significant indicators of the presence of latent BrS in young patients with lone atrial fibrillation.

P4421Increased circulating levels of VCAM-1 correlate with left atrial remodeling in highly trained athletes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Gabrielli ◽  
L Garcia ◽  
R Fernandez ◽  
J Vega ◽  
M P Ocaranza ◽  
...  
Keyword(s):  
Left Atrial ◽  
Posterior Wall ◽  
Serum Levels ◽  
P Value ◽  
Atrial Remodeling ◽  
Marathon Runners ◽  
Potential Biomarker ◽  
Increased Risk ◽  
Group 2 ◽  
Group 1

Abstract Introduction Reports have shown increased risk of atrial fibrillation (AF) in athletes. Vascular cell adhesion molecule-1 (VCAM1) is associated with new onset AF in general population. VCAM1 and its relation with left atrial (LA) remodeling have not been investigated in athletes. Purpose To study VCAM1 and LA remodeling in marathon runners. Methods Study of 36 male marathon runners in the training period previous to race (42 km) and 18 sedentary controls with no risk factors. Athletes were divided in two groups according to highest training intensity reached (group 1, >100 km/week; group 2, 50–100 km/week). Previous to race in all subjects, VCAM1 serum levels were measured by ELISA and an echocardiogram was performed. In athletes, VCAM1 was measured immediately post-race. Wilcoxon and Spearman were used. Results See table. Group 1 showed a significant increment in VCAM1 post-race (651±350 to 905±373 ng/mL; p=0.002) as compared to group 2 with no increment (533±133 to 651±138 ng/mL; p=0.117). In athletes, a moderate correlation between LA volume and VCAM1 was found (rho: 0.483; p=0.007). Baseline characteristics Group 1 (n=18) Group 2 (n=18) Controls (n=18) p value Age (years) 37±6 38±5 36±4 0.373 Heart rate (bpm) 53±8 57±7 69±6 * 0.001 Body surface area (m2) 1.8±0.1 1.8±0.1 1.9±0.1 0.075 LV diastolic diameter (mm) 49±5 48±5 46±4 0.404 LV systolic diameter (mm) 29±5 30±5 30±4 0.879 Septal wall (mm) 9.1±1.2† 8.2±1.1 8.1±0.8 0.005 Posterior wall (mm) 9.3±2.1† 8.5±1.2 7.6±0.8 0.001 Ejection fraction (%) 55±3 55±6 57±4 0.110 LV mass index (g/m2) 106±27† 78±18 58±11 0.001 LA volume (mL/m2) 42±8† 30±11 25±9 0.001 E wave (cm/sec) 78±13 84±12 77±15 0.217 A wave (cm/sec) 50±12 53±10 48±16 0.438 DT (msec) 233±65 229±65 221±66 0.184 VCAM1 (ng/mL) 651±350† 533±133 440±98 0.022 Mean ± SD. *p<0.05 vs group 1 and 2 post Kruskall-Wallis; †p<0.05 vs other groups post Kruskall-Wallis. LV, left ventricle; LA, left atrium; DT, deceleration time. Conclusions Most trained athletes had increased levels of VCAM1 as compared to controls and less trained athletes. They also showed an increment post-effort. VCAM1 is related to LA remodeling in athletes. VCAM1 could be a potential biomarker of AF in athletes which should be confirmed. Acknowledgement/Funding FONDECYT 1170963 (LG); FONDAP 15130011 (LG,SL)

scholarly journals Prediction of sinus rhythm maintenance after radiofrequency ablation in patients with atrial fibrillation using speckle tracking echocardiography and dynamics of left atrial structural and functional parameters

2021 ◽  
Vol 26 (2S) ◽  
pp. 4256
Author(s):  
T. I. Musin ◽  
Z. A. Bagmanova ◽  
D. A. Gareev ◽  
V. G. Rudenko ◽  
N. Sh. Zagidullin
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Predictive Value ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Reverse Remodeling ◽  
Group 2 ◽  
Sinus Rhythm Maintenance ◽  
Group 1

Aim. To evaluate the dynamics of left atrial volume (LAV), strain (S) during the reservoir phase and strain rate (SR) in patients with paroxysmal and persistent atrial fibrillation (AF), scheduled for catheter radiofrequency ablation (RFA), as well as to compare the predictive value of S and SR as a marker of maintaining sinus rhythm.Material and methods. A total of 19 patients (men, 11; women, 8) aged 62±10,7 years with AF were included in the study, 13 (67%) of whom had persistent AF, while 6 patients (33%) had paroxysmal AF Two-dimensional and speckle tracking N. Sh. echocardiography (EPIQ 7, Philips) were performed in all patients before ablation and 12 months after RFA.Results. The patients were divided into 2 groups: group 1 — no recurrent AF after RFA (n=12; 63%); group 2 — recurrent AF after RFA (n=7; 37%). According to 2D echocardiography, the baseline values of LAV and LAV index (LAVI) did not significantly differ between groups 1 and 2: 56,0±12,6 ml and 52,0±23,2 ml (p=0,78); 28,0±7,8 ml/m2 and 25,1±13,6 ml/m2 (p=0,85), respectively. The initial S values of the LA in the four-chamber (4C-) and two-chamber (2C-) apical views in group 1patients were higher than in those from group 2: 4C-S, 34,3±9,9% and 16,9±4,4% (p=0,0008); 2C-S, 29,2±8,3% and 14,5±4,4% (p=0,0011), respectively. Baseline SR values were higher in group 1 patients compared with group 2 in 4C- and 2C-views: 4C-SR, 2,36±0,37 s-1 and 1,39±0,50 s-1 (p=0,0013); 2C-SR 2,09±0,39 s-1 and 1,4±0,53 s-1 (p=0,0053), respectively. The LAV in group 1 became significantly less after RFA than its initial levels: 56,0±12,6 ml and 47,0±12,1 ml (p=0,008). The LAVI also significantly decreased 12 months after RFA as follows: 28,0±7,8 ml/m2 and 22,6±8,3 ml/m2 (p=0,02). In group 2, there was no decrease in either LAV or LAVI after 12 months: LAV, 52,0±23,2 ml and 54,0±12,1 ml (p=1,0); LAVI, 25,1±13,6 ml/m2 and 30,9±7,6 ml/m2 (p=0,3). In group 1, there was no significant change in LA S 12 months after RFA: 4C-S, 34,3±9,9% and 30,3±9,6% (p=0,287); 2C-S, 29,2±8,3% and 28,9±9,1% (p=0,82). In group 2, LA S levels in 4C- and 2C-views did not significantly change depending on the performed RFA procedure: 4C-S, 16,9±4,4% and 17,4±6,2% (p=0,12); 2C-S, 14,5±4,4% and 16,5±6,8% (p=1,0). According to the ROC analysis, the optimal cut-off values for baseline 4C-SR (1,8 s-1 (AUC=0,958)), 2C-SR (1,75 s-1 (AUC=0,899)), 4C-S (20,7% (AUC=0,976)), and 2C-S (19,2% (AUC=0,964)) were reliable individual predictors of sinus rhythm maintenance.Conclusion. A stable sinus rhythm 12 months after the RFA was maintained in patients with higher baseline LA S and SR levels. The baseline LA S and SR values have a high predictive value for AF recurrence in patients after RFA. In patients with effective RFA, LAV and LAVI decreased without changing the S and SR. There was no effect of LA reverse remodeling and improvement in LA S values in patients with recurrent AF after RFA.

scholarly journals High level of growth differentiation factor 15 and lower left ventricular ejection fraction as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A.V Belokurova ◽  
T.P Gizatulina ◽  
N.Y.U Khorkova ◽  
L.U Martyanova ◽  
T.I Petelina ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Roc Analysis ◽  
Left Ventricular ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
Group 2 ◽  
High Level ◽  
Group 1

Abstract Background The presence of left atrial/left atrial appendage (LA/LAA) thrombus is used as a surrogate marker of potential stroke in patients (pts) with atrial fibrillation (AF). Purpose To assess the role of growth differentiation factor 15 (GDF-15) level, clinical and echocardiographic (EchoCG) data as predictors of LA/LAA thrombus in pts with nonvalvular AF. Methods Out of 158 pts with nonvalvular AF admitted to Cardiology Center for radiofrequency ablation or elective cardioversion in 2019–2020 2 groups were formed according to transesophageal EchoCG results: group 1 included pts without LA/LAA thrombus (n=102, mean age 59.5±6.0 years) and group 2 (n=42, mean age 60.9±8.8 years) – pts with LA/LAA thrombus. Arterial hypertension was found in 93 pts of group 1 (91%) and in 40 pts of group 2 (95%, p=0.42), coronary artery disease - in 53 pts (52%) and 29 pts (69%), respectively (p=0.06). Both groups did not differ in frequency and spectrum of oral anticoagulants administration. General clinical assessment, EchoCG, and laboratory tests were performed, including GDF-15 (pg/ml) levels using Human GDF-15/MIC-1 ELISA kit and NT-proBNP (pg/ml) in blood. Results Pts with LA/LAA thrombus more often had persistent AF, while paroxysmal AF was more common in pts without thrombus. There was a tendency to more significant congestive heart failure in group 2. Mean CHA2DS2-VASc score was higher in pts with LA/LAA thrombus, also there was a tendency to a larger proportion of pts with scores ≥3. According to EchoCG data, sizes and volumes of both atria, right ventricle, end-systolic volume, left ventricular (LV) size, pulmonary artery systolic pressure and LV mass index were higher in group 2; LV ejection fraction (LVEF) was normal in both groups, but it was significantly lower in pts with LA/LAA thrombus: 59.1±5.1 and 64.0±7.3, respectively (p&lt;0.001). GDF-15 and NT-proBNP levels were significantly higher in group 2 compared to group 1: p=0.00025 and p=0.ehab724.048801 respectively. According to ROC analysis cut-off were set at level &gt;935.0 pg/ml for GDF-15 (AUC=0.705, 95% CI 0.609–0.800, p&lt;0.001) and &gt;143 pg/ml for NT-proBNP (AUC=0.759, 95% CI 0.670–0.849, p&lt;0.001). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: GDF-15 &gt;935.0 pg/ml (OR=4.132, 95% CI 1.305–13.084) and LVEF (OR=0.859, 95% CI 0.776–0.951). According to ROC analysis, the model had a good quality: AUC=0.776 (p&lt;0.001), sensitivity was 78.3%., specificity - 78.3%. Conclusion High level of GDF-15 (&gt;935.0 pg/ml) along with lower LVEF are independent predictors of LA/LAA thrombus in pts with nonvalvular AF. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 9576: Predictors of Silent Cerebral Events Detected on Magnetic Resonance Imaging in Patients After Atrial Fibrillation Ablation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Thomas Deneke ◽  
Karin Nentwich ◽  
Patrick Müller ◽  
Markus Roos ◽  
Joachim Krug ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Resonance Imaging ◽  
Af Ablation ◽  
Cerebral Mri ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Introduction: Silent cerebral events (SCE) have been identified on magnetic resonance imaging (MRI) in asymptomatic patients after atrial fibrillation (AF) ablation. Silent cerebral lesions represent irreversible cerebral damage, comparative analysis using a consistent MRI definition is missing and factors influencing the risk of SCE are poorly understood. Methods: 351 Patients undergoing AF ablation underwent post-ablation cerebral MRI. SCE were identified based on a sensitive definition using a 1.5Tesla MRI including DWI and ADC-map (but not including FLAIR). AF ablation was performed either using irrigated single-tip radiofrequency (RF) ablation (group 1, N=73), phased RF pulmonary vein isolation (PVI) (group 2, N=129), endoscopically-guided laser balloon (group 3, N=41), cryo-balloon PVI (group4, N=34) and irrigated RF multipolar catheters (nMARQ) (group 5, N=73). Differences in regard to SCE rates were analyzed. Results: In group 1 22%, in group 2 37%, in group 41%, in group 4 21% and in group 5 27% of patients had documented SCE. There was a significantly higher incidence of SCL in patients with compared to without exchanges of catheters over a single transseptal sheath (34% vs. 18%, p=0.007) and in patients with left atrial dilation (48% vs. 30%, p=0.01). In a subgroup analysis incidence of SCE was lower when patients were ablated under continued oral anticoagulation (11%) compared to novel oral anticoagulants (33%) or without continuous appropriate anticoagulation bridged with low-molecular weight heparin (45%). Documented left atrial low-voltage areas were associated with a higher incidence of SCE (46% versus 24% in the control group). Conclusions: When using a sensitive MRI definition of SCE incidences are relevantly higher compared to using the “old” definition including the FLAIR-sequence. Technology-associated and procedural characteristics associated with a higher risk of SCE have been identified. Modification of procedural steps of the AF ablation procedure may further reduce the risk of SCE.

scholarly journals Clinicopathological Bird’s-Eye View of Left Atrial Myocardial Fibrosis in 121 Patients With Persistent Atrial Fibrillation

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Sergio Callegari ◽  
Emilio Macchi ◽  
Rodolfo Monaco ◽  
Luca Magnani ◽  
Alessandro Tafuni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Rheumatic Disease ◽  
Left Atrial ◽  
Type I Collagen ◽  
Mesenchymal Cells ◽  
Type I ◽  
Atrial Fibrosis ◽  
Group 2 ◽  
Mitral Disease ◽  
Group 1

Background: Scientific research on atrial fibrosis in atrial fibrillation (AF) has mainly focused on quantitative or molecular features. The purpose of this study was to perform a clinicoarchitectural/structural investigation of fibrosis to provide one key to understanding the electrophysiological/clinical aspects of AF. Methods: We characterized the fibrosis (amount, architecture, cellular components, and ultrastructure) in left atrial biopsies from 121 patients with persistent/long-lasting persistent AF (group 1; 59 males; 60±11 years; 91 mitral disease–related AF, 30 nonmitral disease–related AF) and from 39 patients in sinus rhythm with mitral valve regurgitation (group 2; 32 males; 59±12 years). Ten autopsy hearts served as controls. Results: Qualitatively, the fibrosis exhibited the same characteristics in all cases and displayed particular architectural scenarios (which we arbitrarily subdivided into 4 stages) ranging from isolated foci to confluent sclerotic areas. The percentage of fibrosis was larger and at a more advanced stage in group 1 versus group 2 and, within group 1, in patients with rheumatic disease versus nonrheumatic cases. In patients with AF with mitral disease and no rheumatic disease, the percentage of fibrosis and the fibrosis stages correlated with both left atrial volume index and AF duration. The fibrotic areas mainly consisted of type I collagen with only a minor cellular component (especially fibroblasts/myofibroblasts; average value range 69–150 cells/mm 2 , depending on the areas in AF biopsies). A few fibrocytes—circulating and bone marrow-derived mesenchymal cells—were also detectable. The fibrosis-entrapped cardiomyocytes showed sarcolemmal damage and connexin 43 redistribution/internalization. Conclusions: Atrial fibrosis is an evolving and inhomogeneous histological/architectural change that progresses through different stages ranging from isolated foci to confluent sclerotic zones which—seemingly—constrain impulse conduction across restricted regions of electrotonically coupled cardiomyocytes. The fibrotic areas mainly consist of type I collagen extracellular matrix and, only to a lesser extent, mesenchymal cells.

Abstract 15065: Impact of Ablation Strategy on Left Ventricular Function Following Catheter Ablation in Patients With Long-standing Persistent Atrial Fibrillation and Heart Failure: Results From a Single-center Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
CHINTAN G TRIVEDI ◽  
Faiz Baqai ◽  
Domenico G Della Rocca ◽  
Carola Gianni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Background: Ablation strategy for long-standing persistent atrial fibrillation (LSPAF) is highly variable with diverse outcomes. Objective: We evaluated the change in left ventricular ejection fraction (LVEF) with different ablation approaches in LSPAF patients with heart failure (HF). Methods: Consecutive LSPAF patients with HF (LVEF <40%) undergoing their first catheter ablation at our center were included in the analysis. Based on the ablation strategy determined by the operators, patients were classified into two groups; group 1: received standard ablation (PV isolation+ isolation of left atrial posterior wall and superior vena cava) and group 2: standard ablation plus isolation of coronary sinus (CS) and left atrial appendage (LAA). High-dose isoproterenol challenge (20-30 μg for 10-15 min) was utilized to reveal LAA and CS triggers; electrical isolation was the procedural endpoint for LAA and CS ablation. If PVs were electrically silent due to presence of severe scar, LAA and CS were empirically isolated even in the absence of detectable triggers. LVEF was measured by transesophageal echocardiogram (TEE) performed at baseline and 6 months post-ablation. Patients were monitored for arrhythmia-recurrence off-antiarrhythmic drugs (AAD) as per our standard protocol. Results: Group 1 included 52 patients and group 2 had 106. Baseline characteristics were comparable across groups (age: 66.2 ± 7.3 and 64.4 ± 9.4; male: 41 (78.8%) and 87 (82.1%); BMI: 32.3 ± 6.8 and 30.4 ± 6.4 in group 1 and 2). Mean baseline LVEF (%) was 36.2±5.5 and 35.1±8.3 in group 1 and 2 respectively (p=NS). At the 6-month TEE, mean LVEF was significantly higher than the baseline value in group 2 (47.7±11 vs 35.1±8.3, p<0.001), whereas in group 1, although there was a positive trend, the change was statistically non-significant (39.4±10 vs. 36.2±5.5, p=0.36). A total of 7 (13.5%) patients from group 1 and 89 (84%) from group 2 were arrhythmia-free off-AAD at 1.5 year of follow-up (p<0.001). Conclusion: In our study population, ablation strategy including LAA and CS isolation along with the standard ablation resulted in significant improvement in the LVEF as well as higher rate of arrhythmia-free survival.

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