scholarly journals Impact of left atrial volume, sphericity, and fibrosis on the outcome of catheter ablation for atrial fibrillation

2018 ◽  
Vol 29 (5) ◽  
pp. 740-746 ◽  
Author(s):  
Dennis W. den Uijl ◽  
Nuno Cabanelas ◽  
Eva M. Benito ◽  
Rosa Figueras ◽  
Francisco Alarcón ◽  
...  

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mark S Brahier ◽  
Fengwei Zou ◽  
Frank Migliarese ◽  
Milos Tomovic ◽  
Alexandra Taylor ◽  
...  

Background: Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation. Methods: The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index. Results: Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors. Conclusions: Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.



2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.M Farinha ◽  
M Fonseca ◽  
L Parreira ◽  
A.F Esteves ◽  
A Pinheiro ◽  
...  

Abstract Introduction Left atrial volume (LAV) is an accepted predictor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation, stronger than AF duration. Objective The aim of this study was to assess the value of left atrial stiffness (LAS) index as a new parameter evaluated by echocardiography to the prediction of AF recurrence after radiofrequency catheter ablation. Methods We retrospectively studied consecutive patients with paroxysmal or persistent AF submitted to radiofrequency catheter ablation at our institution between 2017 and 2019. We used transthoracic echocardiography to measure the LAV indexed to body surface area and the LAS index, defined as the ratio between the mitral E/e' (obtained with pulsed Doppler at the tip of the mitral leaflets – E, and tissue Doppler imaging at the mitral annulus – e') and the left atrial strain during the reservoir phase (obtained by speckle tracking echocardiography) [LAS index = (E/e') / LA reservoir strain]. The left ventricular ejection fraction (LVEF) was also evaluated. Patients with poor quality echocardiographic images were excluded. We compared 2 groups of patients, according to the recurrence of AF after the blanking period. We analysed the clinical characteristics and echocardiographic findings. The effect of clinical and echocardiography parameters on AF recurrence was evaluated by univariate and multivariate Cox Regression analysis. Results We studied 33 patients, 27 with paroxysmal AF and 6 with persistent AF. Baseline patients' characteristics are presented in Table 1. During a mean follow-up time of 17.9±10.4 months, 7 patients (21%) had AF recurrence, and none died. Patients with AF recurrence had a higher LAS index. After adjusting for confounding variables, only LAS index and LAV were independently associated with AF recurrence (Table 2). Every one unit increase in LAS index was associated with an 11-fold increased risk of AF recurrence (HR 10.86, 95% CI 1.38–85.56; p=0.024), while every one unit increase in LAV index was only associated with a 6% increased risk of AF recurrence (HR 1.06, 95% CI 1.01–1.11, p=0.010). Conclusion LAS index evaluated by echocardiography was a much stronger predictor of AF recurrence after radiofrequency catheter ablation than left atrial volume. FUNDunding Acknowledgement Type of funding sources: None.





Medicine ◽  
2021 ◽  
Vol 100 (29) ◽  
pp. e26513
Author(s):  
Muktapha Sangsriwong ◽  
Gabriel Cismaru ◽  
Mihai Puiu ◽  
Gelu Simu ◽  
Sabina Istratoaie ◽  
...  


2009 ◽  
Vol 20 (9) ◽  
pp. 1005-1010 ◽  
Author(s):  
IRENE HOF ◽  
KARUNA CHILUKURI ◽  
ARMIN ARBAB-ZADEH ◽  
DANIEL SCHERR ◽  
DARSHAN DALAL ◽  
...  


2016 ◽  
Vol 48 (2) ◽  
pp. 201-207 ◽  
Author(s):  
Giuseppe Stabile ◽  
Matteo Anselmino ◽  
Ezio Soldati ◽  
Ermengildo De Ruvo ◽  
Francesco Solimene ◽  
...  


2015 ◽  
Vol 184 ◽  
pp. 56-61 ◽  
Author(s):  
Francisco Moscoso Costa ◽  
António Miguel Ferreira ◽  
Sílvia Oliveira ◽  
Pedro Galvão Santos ◽  
Anai Durazzo ◽  
...  


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