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

QJM ◽  
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%.

scholarly journals A comprehensive model to estimate underlying atrial fibrillation in cryptogenic stroke: the decrypting score

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Cecconi ◽  
A Vera ◽  
A Ximenez-Carrillo ◽  
C Ramos ◽  
P Martinez-Vives ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Clinical Laboratory ◽  
Troponin T ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
P Wave ◽  
Unknown Etiology ◽  
Clinical Tool ◽  
Left Atrial Strain

Abstract Introduction Cryptogenic stroke (CS) represents up to 30% of ischemic strokes. Since atrial fibrillation (AF) can be detected in up to one-third of CS, there is a clinical need for estimating the probability of underlying AF in CS to guide the optimal secondary prevention strategy. Surrogate markers of left atrial dysfunction such as left atrial size, left atrial strain (LAS) and NTproBNP has been described as predictors of AF in patients with CS. However the evidence about AF markers in comprehensive and prospective studies in CS is still limited. Purpose The present study was designed to develop the first score to predict underlying AF in CS patients that includes markers of atrial dysfunction. To reach our aim we developed a comprehensive analysis including clinical, laboratory, electrocardiografic and advanced echocardiographic variables in patients with CS. Methods Sixty-three consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Clinical, laboratory, electrocardiografic and echocardiographic variables were collected. All patients underwent 15 days wearable Holter monitoring. Main objective was the Decryptoring score creation to predict AF in CS. Score variables were initially selected by a univariate logistic regression and, thereafter, the score points were derived according to a multivariant analysis. Results AF was detected in 15 patients (24%). Patients in the AF group were older (81.4±6.9 vs 76.5±7.8 years; p=0.035. There was no difference in sex between groups. Regarding cardiovascular risk factors patients who developed AF had more often hypertension (87% vs 52%; p=0.018) without differences in diabetes, dyslipidemia and tobacco consumption. T troponin and NTproBNP were higher in the AF group (47±55.9 vs 16.8±12.4 ng/L; p=0.018 and 1379±1650 vs 317±496 ng/ml; p=0.001 respectively). There were no differences in ECG parameters such as p wave voltage, interatrial block, PR interval or QRS. LAS reservoir, LAS conduct and LAS contraction were lower in patients with AF (18.6±4.6 vs 32.1±10.9%; 8±4.3 vs 15.6±8%; 10.5±3.4 vs 16.6±7 respectively, all p<0.001). Age >75 (9 points), hypertension (1 point), Troponin T >40 ng/L (8.5 points), NTproBNP >200 pg/ml (0.5 points), LAS reservoir <25.3% (24.5 points) and LAS conduct <10.4% (0.5 points) were included in the score. The rate of AF detection was 0% among patients with a score of <10 and 80% among patients with a score >35. Conclusion The proposed score offers an accurate AF prediction in patients with CS providing a new clinical tool to orient the optimal treatment in these patients. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology

Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jorge Pagola ◽  
Jesus Juega ◽  
Jaume Francisco ◽  
Maite Rodriguez ◽  
Juan Antonio Cabezas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cumulative Incidence ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Holter Monitoring ◽  
Cardiac Monitoring ◽  
Atrial Volume ◽  
Monitoring Time ◽  
Number Of Patients

Introduction: External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke. Methods: A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed. Results: A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p<0.001). Conclusions: In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.

Abstract 3648: Detection Of Paroxysmal Atrial Fibrillation In Patient With Acute Brain Ischemia Combining Cardiac And Holter Monitoring: Prevalence And Predictors

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Patricia Martinez-Sanchez ◽  
Elisa Correas Callero ◽  
Andres Cruz Herranz ◽  
Blanca Fuentes Gimeno ◽  
Angel Martin Montes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Brain Ischemia ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Duplex Ultrasound ◽  
Unknown Origin ◽  
Holter Monitoring ◽  
Cardiac Monitoring ◽  
Stroke Severity ◽  
Carotid Plaques

INTRODUCTION: The yield of serial electrocardiograms (ECG) plus 72-hour cardiac monitoring and Holter monitoring in detection of paroxysmal atrial fibrillation (PAF) is not well known. METHODS: consecutive patients with stroke or transient ischemic attack (TIA) admitted to a Stroke Unit (SU) during January 2009-June 2010 were studied. Patients underwent serial ECG and cardiac monitoring in the first 72 hours. Furthermore, 24-hours Holter monitoring were performed in patient with brain ischemia of unknown origin or if cardiac embolism was suspected. The presence of atrial fibrillation (AF) and PAF was recorded. RESULTS: 537 patients were included, 59.6% males. Mean age 69.1 (SD 13.5) years. Previous AF was present in 15.8% patients. ECG on admission showed not previously known AF in 22 (4%) patients. Cardiac monitoring and serial ECG in the SU detected PAF in 12 (2.2%) cases more. 24-hours Holter monitoring was completed in 156 patients, in 42 cases PFA was detected, of them 6 had been previously detected by serial ECG/cardiac monitoring. One case of PAF detected by serial ECG was not confirmed by Holter monitoring. In total, 10.8% of patients were diagnosed with new PAF. In multivariate analyses, NIHSS on admission (OR 1.1 for each 1 point increase; 95% CI, 1-1.2), enlarged left atrial (OR 5.8; 95% CI, 2.8-12), absence of carotid plaques by duplex ultrasound (OR 2.1; 95% CI 1-4.4) and hyperlipidemia (OR 2.4; 95% CI 1.119-5) were predictors of PAF. CONCLUSIONS: 24-hours Holter monitoring increased by 6 fold the detection of PAF as compared to ECG plus cardiac monitoring in acute stroke patients. Stroke severity, enlarged left atrial, absence of carotid plaques and hyperlipidemia are associated with PAF.

P3383Left atrial appendage and left atrial morphology is associated with cryptogenic stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Adukauskaite ◽  
F Barbieri ◽  
T Senoner ◽  
F Plank ◽  
M Knoflach ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Cryptogenic Stroke ◽  
Patient Characteristics ◽  
Atrial Appendage ◽  
P Value ◽  
Clinical Patient

Abstract Background Stroke causes a high burden of morbidity and mortality worldwide. Approximately 30% of stroke cases remain cryptogenic (CS), of which one third is due to occult atrial fibrillation (AF) with left atrial appendage (LAA) being the most frequent thrombus source. Hence, aim of our study was to assess if LAA morphological parameters analysed by computed tomography angiography (CTA) are associated with CS. Methods and materials In 184 patients (Table 1), 82 CS patients and 102 controls (age median 62 (52,2–72), 40.2% females), matched for BMI, a CTA was performed, and LAA morphology evaluated retrospectively. LAA morphology was classified into 5 types (Figure 1): Cactus, Cauliflower, Chicken-wing, Windsock and the new “Seahorse” with a distinctive tip angulation of ≤90° and 2 bends (Z-shape). Further measurements included: LAA tip angulation (≤90°, 91–110°, >110°), LAA lobe number, LAA ostium size (length) and angulation, left atrium wall thickness (LAWT). Results LAA and left atrium (LA) parameters associated with CS on multivariable analysis after adjusting for CHA2DS2-VASc score were: Chicken-wing type (OR 2.15; 95% CI: 1.01–4.56, p=0.046), a greater lobe number (OR 2.01; 95% CI: 1.52–2.64, p<0.001), a greater middle and mean LAWT (respectively, OR 2.13; 95% CI: 1.49–3.05, p<0.001, OR 2.64; 95% CI: 1.63–4.29, p<0.001), a larger (length, OR 1.08; 95% CI: 1.0–1.16, p=0.039) and a less bent LAA ostium (OR 1.02; 95% CI: 1.01–1.03, p=0.006). In contrast, a sharp-angled LAA tip (≤90°) was protective from CS (OR 0.43; 95% CI: 0.23–0.83, p=0.012) on multivariable analysis. Table1. Clinical patient characteristics CS (n=82) Non-stroke (n=102) p value Females 21 (25.6%) 53 (52%) p<0.001 Age, y 66.5 (57–73) 57.5 (50–70) 0.001 BMI, kg/m2 25.6 (23.9–28.2) 26 (23.3–30.1) 0.320 CHA2DS2-VASc score 2 (1–3) 2 (1–3) 0.387 AF (paroxysmal/permanent) 0 4 0.071 Hypertension 68 (82.9%) 54 (56.3%) p<0.001 Diabetes mellitus, type 2 16 (19.8%) 11 (11.5%) 0.145 Values are given in median ± IQR. AF, atrial fibrillation; BMI, body mass index. LAA and LA morphology in CTA. Conclusion In CS, a Chicken-wing LAA, a greater number of lobes and a thicker LA wall are independently associated with CS while a sharp LAA tip (≤90°) mostly seen in Seahorse type LAA is protective. Such “high-risk” LAA and LA morphology could help to select CS patients benefiting from extended rhythm-monitoring to detect an occult AF, however, further prospective studies are needed to confirm this hypothesis.

scholarly journals Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

2019 ◽  
Vol 8 (11) ◽  
pp. 2002 ◽  
Author(s):  
Chrissoula Liantinioti ◽  
Lina Palaiodimou ◽  
Konstantinos Tympas ◽  
John Parissis ◽  
Aikaterini Theodorou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Waveform Analysis ◽  
Potential Utility ◽  
Arrhythmia Detection ◽  
Holter Ecg ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

Background: Occult paroxysmal atrial fibrillation (PAF) is a common and potential treatable cause of cryptogenic stroke (CS). We sought to prospectively identify independent predictors of atrial fibrillation (AF) detection in patients with CS and sinus rhythm on baseline electrocardiogram (ECG), without prior AF history. We had hypothesized that cardiac arrhythmia detection during neurosonology examinations (Carotid Duplex (CDU) and Transcranial Doppler (TCD)) may be associated with higher likelihood of AF detection. Methods: Consecutive CS patients were prospectively evaluated over a six-year period. Demographics, clinical and imaging characteristics of cerebral ischemia were documented. The presence of arrhythmia during spectral waveform analysis of CDU/TCD was recorded. Left atrial enlargement was documented during echocardiography using standard definitions. The outcome event of interest included PAF detection on outpatient 24-h Holter ECG recordings. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: A total of 373 patients with CS were evaluated (mean age 60 ± 11 years, 67% men, median NIHSS-score 4 points). The rate of PAF detection of any duration on Holter ECG recordings was 11% (95% CI 8%–14%). The following three variables were independently associated with the likelihood of AF detection on 24-h Holter-ECG recordings in both multivariate analyses adjusting for potential confounders: age (OR per 10-year increase: 1.68; 95% CI: 1.19–2.37; p = 0.003), moderate or severe left atrial enlargement (OR: 4.81; 95% CI: 1.77–13.03; p = 0.002) and arrhythmia detection during neurosonology evaluations (OR: 3.09; 95% CI: 1.47–6.48; p = 0.003). Conclusion: Our findings underline the potential utility of neurosonology in improving the detection rate of PAF in patients with CS.

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

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 &gt; 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&gt; 165 pg / ml (OR 11.3 [95% CI 1.2-102.9] p = 0.031), LA reservoir strain &lt;19.1% (OR 7.7 [IC 95 % 1.5-40.0] p = 0.016) and LA conduct strain &lt;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 &gt; 165 pg/ml 12 (41%) 8 (89%) OR 11.3 [IC 95% 1.2-102.9]; p = 0.031 Reservoir LA strain &lt;19.1% 6 (20%) 6 (67%) OR 7.7 [IC 95% 1.5-40.0]; p = 0.016 Conduct LA strain &lt;9.1% 9 (31%) 7 (78%) OR 7.8 [IC 95% 1.3-45.1]; p = 0.022

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

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Pilichowska ◽  
A Sikorska ◽  
J Baran ◽  
R Piotrowski ◽  
T Krynski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Speckle Tracking ◽  
The Body ◽  
P Value ◽  
Rf Ablation ◽  
Funding Sources ◽  
Baseline Values ◽  
Funding Acknowledgements

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 [sˉ&sup1;] 1.18 ± 0.22 1.27 ± 0.26 0.046 1.07 ± 0.27 1.18 ± 0.30 0.041 0.141 Global LASRcd [sˉ&sup1;] -1.11 ± 0.33 -1.25 ± 0.35 0.013 -1.07 ± 0.31 -1.16 ± 0.30 0.044 0.214 Global LASRct [sˉ&sup1;] -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

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 &lt;0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA &lt;10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA &gt;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 &gt;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 &lt;10% n = 13 Group 2 LAPA &gt;10% &lt;40% n = 13 Group 3 LAPA &gt;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 &lt;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 &lt;0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 &lt;0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 &lt;0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178

scholarly journals Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahmet Demirkiran ◽  
Raquel P. Amier ◽  
Mark B. M. Hofman ◽  
Rob J. van der Geest ◽  
Lourens F. H. J. Robbers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Flow Velocity ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Peak Flow ◽  
Thrombus Formation ◽  
Clinical Value ◽  
4D Flow ◽  
Ssfp Cine

AbstractThe pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.

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