P402Analysis of right atrium remodeling by cardiac magnetic resonance in patients with atrial fibrillation and its association with left atrium

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Gunturiz Beltran ◽  
R Borras-Amoraga ◽  
F Alarcon ◽  
P Garre ◽  
R Figueras ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Healthy Volunteers ◽  
Left Atrium ◽  
Right Atrium ◽  
Cox Regression ◽  
Structural Heart Disease ◽  
Moderate Correlation ◽  
Arrhythmogenic Substrate

Abstract Funding Acknowledgements none Background Atrial fibrillation (AF) causes changes in atrial anatomy and this remodeling leads to the arrhythmogenic substrate. Most studies with cardiac magnetic resonance-late gadolinium enhancement (CMR-LGE) have focused on the left atrium (LA); The role of the right atrium (RA) in AF is unknown. Purpose To evaluate RA remodeling parameters and its comparison with LA in patients with AF. Methods Observational study. We included 109 patients: 9 healthy volunteers, 55 paroxysmal AF, 45 persistent AF. All of them had a CMR-RTG 3.0 T. Image post-processed with segmentation of both atria. Comparison of mean parameters of RA and LA (T test), correlation between them (R Pearson). Multivariate analysis (Cox regression) to study predictive factors. Results AF patients had a mean age of 58.5 ± 10.5 years, 70(70%) were men, without structural heart disease 80(80%), and associated atrial flutter 11(11%). The RA parameters were compared by subgroups. We found differences in (healthy/paroxAF/persistAF): area(cm2) 94.0 ± 15.9 /125.3 ± 20.8/ 152.8 ± 24.4 (p <0.0001); volume (ml) 76.7 ± 19.6/ 107.0 ± 25.6/ 150.9 ± 37.6 (p <0.0001); and total fibrosis (%) 3.7 ± 4.3/ 16.5 ± 14.1/ 19.4 ± 15.9 (p 0.014). RA was higher than LA in all subgroups. There was more fibrosis in RA in paroxysmal/persistent AF. Both types of AF had at least a moderate correlation for area, volume and fibrosis (table). Finally, RA sphericity was the only predictor factor of AF recurrence after ablation among RA remodeling parameters (HR 1.1 95%CI [1.0 -1.3], p = 0.049). Conclusions Area, volume and fibrosis progressively increased from healthy to paroxysmal AF, and then to persistent AF. RA was higher than LA and it also had more fibrosis in patients with AF. The size and fibrosis between both atria had at least moderate correlation. The RA sphericity was a predictor of post-ablation AF recurrences. COMPARISON/CORRELATION RA LA p R PEARSON(RA/LA) p HEALTHY VOLUNTEERS Volume (ml) 76.7 ± 19.6 37.0 ± 9.4 <0.0001 0.457 0.254 Total Fibrosis (%) 3.7 ± 4.3 5.0 ± 6.1 0.278 0.837 0.005 PAROXYSMAL AF Volume (ml) 107.0 ± 25.6 69.5 ± 26.5 <0.0001 0.422 0.001 Total Fibrosis (%) 16.5 ± 14.1 8.0 ± 8.6 <0.0001 0.485 <0.0001 PERSISTENT AF Volume (ml) 150.9 ± 37.6 103.2 ± 28.5 <0.0001 0.582 <0.0001 Total Fibrosis (%) 19.4 ± 15.9 10.5 ± 11.7 <0.0001 0.571 <0.0001 Abstract Figure. Correlation of area and fibrosis RA/LA

P605Correlation of left atrial phasic transport function and arrhythmogenic substrate in patients with atrial fibrillation: cardiac magnetic resonance feature tracking and bipolar voltage mapping

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Schoenbauer ◽  
J Tomala ◽  
B Kirstein ◽  
Y Huo ◽  
T Gaspar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Strain Rates ◽  
Transport Function ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Arrhythmogenic Substrate ◽  
Booster Pump

Abstract Background Bipolar voltage mapping is a widely accepted approach to identify areas of arrhythmogenic substrate in patients presenting for atrial fibrillation (AF) ablation. However, until now little is known about the correlation of left atrial (LA) bipolar voltage distribution and LA transport function. Purpose To study the impact of LA low voltage zones (LVZ) on LA transport function. Methods 107 consecutive patients presenting for ablation of symptomatic AF (34 paroxysmal AF, 73 persistent AF) were prospectively enrolled. Each patient underwent cardiac magnetic resonance imaging (CMR) within 24 hours prior to the ablation procedure. 59 patients were in sinus rhythm (SR) and 48 in AF. LA phasic indexed volumes (LAVi) and ejection fractions were calculated using biplane area length formula. In addition LA phasic strains and strain rates were analyzed using dedicated software (Figure 1A & B). LA bipolar voltage mapping was performed prior to beginning of ablation in sinus rhythm using a 3-dimensional mapping system and LVZ were defined as areas of bipolar voltage <0.5mV. Results LVZ were present in 47 patients (23 in SR). The area of LVZ was 14.6cm2 (5.3–34.0). For patients in AF at the time of CMR only elevated minimal and maximal LAVi (p=0.001 and p=0.002 respectively) but no LA functional parameter was predictive for the occurrence of LVZ. In contrast for patients in SR all LA phasic volumes (endsystolic, pre atrial contraction and enddiastolic LAVi) and LA function parameters (passive, active and total ejection fraction (EF), reservoir, conduit and booster pump strains and strain rates) were predictive for the occurrence of LVZ. After clustered and pooled multivariate logistic regression only impaired booster pump strain rate was still predictive for occurrence of LVZ (OR 0.974, 95% CI 0.950–0.998, p=0.036). In addition Pearson correlation analysis revealed a strong link between LA booster pump functional parameters and cm2 expansion of LVZ areas: LA active EF, LA booster pump strain and SR (r=−0.42, p=0.044; r=−0.47, p=0.024; r=−0.65, p=0.001 [Figure 1C] respectively). Conclusion For patients in SR LA transport function is closely linked to the occurrence of LA LVZ and outperforms LA volumetric measurements for the prediction of LA LVZ. Furthermore LA booster pump function parameters show robust correlation to the extension of LA LVZ.

scholarly journals Termination of atrial fibrillation during pharmacological cardioversion in the goat requires inter-atrial synchronisation of conduction

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Sobota ◽  
A Van Hunnik ◽  
S Zeemering ◽  
G Gatta ◽  
D Opacic ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Conduction Velocity ◽  
Right Atrium ◽  
Path Length ◽  
Cycle Length ◽  
Final Phase ◽  
Periodic Activity ◽  
Bachmann’S Bundle

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ITN Networks PersonalizeAF: Personalized Therapies for Atrial Fibrillation. A Translational Approach, No. 860974; CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly, No. 633196; MAESTRIA: Machine Learning and Artificial Intelligence for Early Detection of Stroke and Atrial Fibrillation, No. 965286; AFib-TrainNet: EU Training Network on Novel Targets and Methods in Atrial Fibrillation, No. 675351 Netherlands Heart Foundation: CVON2014-09, RACE V Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilization in the Progression of Atrial Fibrillation Background Few studies report on mechanisms leading to termination of atrial fibrillation (AF). Purpose To characterise electrophysiological parameters and conduction patterns during the transition from AF to sinus rhythm under various conditions of AF termination. Methods A retrospective evaluation of 6 goat studies was performed. AF was maintained for 3-4 weeks in 29 animals. Four animals were in SR. Unipolar electrograms were acquired with one 249-electrode array/atrium. Pharmacological termination of AF was evoked by various drugs; AP14145 (n = 5), PA6 (n = 7), XAF-1407 (n = 9) vernakalant (n = 8). In animals with sinus rhythm, AF was acutely induced and terminated spontaneously. Baseline AF and ≤3 recordings of the last 10 seconds preceding AF termination were analysed. Intervals with temporal continuous and periodic activity were distinguished in the recordings. AF cycle length (AFCL), conduction velocity and path length were determined for each interval. Results In total, 85 AF terminations were recorded. Switches between temporal continuous and periodic activity were seen frequently during AF. However, termination of AF was always preceded by a phase of periodic activity (PA). The final phase of PA persisted for a median number of 21 [IQR 10-28] cycles in the left atrium and somewhat shorter in the right atrium, Table 1. This final phase of PA was accompanied by a profound bi-atrial increase of AFCL, conduction velocity and path length and a disappearance of inter-atrial cycle length differences. Equipotent changes were not observed in the preceding PAs. During the final AF beats, the number of wave fronts were low, 1 or 2. Interestingly, 92% of the patterns during the last beats of AF involved the Bachmann’s bundle as main source of atrial conduction. Conclusion AF termination is preceded by an increased organisation of fibrillatory conduction, associated with abrupt prolongation of the path length. Propagation in atrial free walls regularly originated from the Bachmann’s bundle. These findings suggest that AF termination was not a random process but follows common spatiotemporal patterns. Final period of temporal organisation Left atrium Right atrium Final PA start Final PA end Final PA start Final PA end Af cycle length (ms) 163 ± 37 204 ± 50* 146 ± 44 207 ± 49* Conduction velocity (cm/s) 77 ± 15 96 ± 25* 83 ± 20 103 ± 24* Path Length (cm) 12.2 ± 2.7 19.3 ± 6.3* 12.0 ± 4.1 21.2 ± 6.4* Length of final periodic activity (beats) NA 21 [IQR 10-28] NA 15 [IQR 10- 25] Electrophysiological changes during the final period periodic activity (PA). Wilcoxon signed rank test. *p &lt;0.05NA= not available

Magnetic resonance-guided re-ablation for atrial fibrillation is associated with a lower recurrence rate: a case–control study

EP Europace ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. 1805-1811
Author(s):  
Levio Quinto ◽  
Jenniffer Cozzari ◽  
Eva Benito ◽  
Francisco Alarcón ◽  
Felipe Bisbal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Magnetic Resonance ◽  
Case Control Study ◽  
Cox Regression ◽  
Three Dimensional ◽  
Case Control ◽  
Conventional Group ◽  
3D Navigation ◽  
Control Study

Abstract Aims Our aim was to analyse whether using delayed enhancement cardiac magnetic resonance imaging (DE-CMR) to localize veno-atrial gaps in atrial fibrillation (AF) redo ablation procedures improves outcomes during follow-up. Methods and results We conducted a case–control study with 35 consecutive patients undergoing a DE-CMR-guided Repeat-pulmonary vein isolation (Re-PVI) procedure. Those with more extensive ablations (e.g. roof lines, box) were excluded. Patients were matched for age, sex, AF pattern, and left atrial dimension with 35 patients who had undergone a conventional Re-PVI procedure guided with a three dimensional (3D)-navigation system. Procedural characteristics were recorded, and patients were followed for 24 months in a specialized outpatient clinic. The primary endpoint was freedom from recurrent AF, atrial tachycardia, or flutter. The duration of CMR-guided procedures was shorter compared to the conventional group (161 ± 52 vs. 195 ± 72 min, respectively, P = 0.049), with no significant differences in fluoroscopy or total radiofrequency time. At the 2-year follow-up, more patients in the DE-CMR-guided group remained free from recurrences compared with the conventional group (70% vs. 39%, respectively, P = 0.007). In univariate Cox-regression analyses, AF pattern [persistent AF, hazard ratio (HR) 2.66 (1.27–5.46), P = 0.006] and the use of DE-CMR [HR 0.36 (0.17–0.79), P = 0.009] predicted recurrences during follow-up; both factors remained independent predictors in multivariate analyses. Conclusion The substrate characterization provided by DE-CMR facilitates the identification of anatomical veno-atrial gaps and associates with shorter procedures and better clinical outcomes in repeated AF ablation procedures.

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