Left ventricular extracellular volume expansion does not predict recurrence of atrial fibrillation following catheter ablation

Abstract Background The Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial has shown that the catheter ablation (CA) for atrial fibrillation (AF) significantly reduced the risk of death and hospitalization for heart failure in patients with non-ischemic dilated cardiomyopathy (NIDCM) and AF (N Engl J Med 2018; 378:417–27). In addition, the Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction (CAMERA-MRI) study demonstrated that the absence of myocardial fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is associated with improvement of left ventricular systolic function after CA in NIDCM patients with AF (J Am Coll Cardiol 2017; 70:1949–61). Extracellular volume fraction (ECV) by T1 mapping has emerges as a non-invasive mean to quantify diffuse myocardial fibrosis. Purpose The aim of this study was to compare the predictive value of LGE-MRI and ECV by T1 mapping for the prediction of improvement of LVEF after CA in NIDCM patients. Methods A total of twenty-eight patients with NIDCM and AF (age: 67±10 years; 25 (89%) male; LVEF: 34.1±8.8%) were studied. Using a 1.5T MR scanner and 32 channel cardiac coils, cine MRI, LGE-MRI, pre- and post- T1 mapping images of LV wall at mid-ventricular level (modified Look-Locker inversion recovery sequence) were acquired. Myocardial fibrosis on LGE was defined as area with >5SD signal intensity of normal myocardium. ECV from six segments of mid ventricular level were averaged for each patient. All patients underwent CA for AF, and the improvement of LVEF before and after CA were evaluated by echocardiography. Results All patients restored sinus rhythm after CA at the time of echocardiography. The mean LVEF was 34.1±8.8% before CA and 49.1±12.0% after CA (p<0.001), resulting an improvement of 15.0±11.8%. Significant correlation was found between improvements in LVEF and amount of fibrosis on LGE-MRI (r=−0.40, p=0.034), improvement of LVEF and ECV (r=−0.55, p=0.008). In the ROC analysis, ECV had a higher discriminative ability for the improvement of LVEF after CA compared with amount of fibrosis on LGE-MRI (AUC 0.885 vs 0.650) (Figure). Conclusions In NIDCM patients with AF, ECV by T1 mapping had better predictive ability for improvement of LVEF after CA in comparison to LGE-MRI. ROC curves of ECV and LGE-MRI Funding Acknowledgement Type of funding source: None

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Extracellular volume fraction by T1 mapping predicts improvement of left ventricular ejection fraction after catheter ablation in patients with non-ischemic dilated cardiomyopathy and atrial fibrillation

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02219-x ◽

2021 ◽

Author(s):

Mai Azuma ◽

Shingo Kato ◽

Ryusuke Sekii ◽

Sho Kodama ◽

Kei Kinoshita ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

T1 Mapping ◽

Volume Fraction ◽

Extracellular Volume ◽

Extracellular Volume Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Non Ischemic Dilated Cardiomyopathy

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Increased NHE3 abundance and transport activity in renal proximal tubule of rats with heart failure

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00127.2011 ◽

2012 ◽

Vol 302 (1) ◽

pp. R166-R174 ◽

Cited By ~ 27

Author(s):

Bruna H. Inoue ◽

Leonardo dos Santos ◽

Thaissa D. Pessoa ◽

Ednei L. Antonio ◽

Bruna P. M. Pacheco ◽

...

Keyword(s):

Heart Failure ◽

Proximal Tubule ◽

Volume Expansion ◽

Extracellular Volume ◽

Left Ventricular ◽

Male Rats ◽

Sodium Reabsorption ◽

Mrna Levels ◽

Transport Activity ◽

Extracellular Volume Expansion

Heart failure (HF) is associated with a reduced effective circulating volume that drives sodium and water retention and extracellular volume expansion. We therefore hypothesized that Na+/H+ exchanger isoform 3 (NHE3), the major apical transcellular pathway for sodium reabsorption in the proximal tubule, is upregulated in an experimental model of HF. HF was induced in male rats by left ventricle radiofrequency ablation. Sham-operated rats (sham) were used as controls. At 6 wk after surgery, HF rats exhibited cardiac dysfunction with a dramatic increase in left ventricular end-diastolic pressure. By means of stationary in vivo microperfusion and pH-dependent sodium uptake, we demonstrated that NHE3 transport activity was significantly higher in the proximal tubule of HF compared with sham rats. Increased NHE3 activity was paralleled by increased renal cortical NHE3 expression at both protein and mRNA levels. In addition, the baseline PKA-dependent NHE3 phosphorylation at serine 552 was reduced in renal cortical membranes of rats with HF. Collectively, these results suggest that NHE3 is upregulated in the proximal tubule of HF rats by transcriptional, translational, and posttranslational mechanisms. Enhanced NHE3-mediated sodium reabsorption in the proximal tubule may contribute to extracellular volume expansion and edema, the hallmark feature of HF. Moreover, our study emphasizes the importance of undertaking a cardiorenal approach to contain progression of cardiac disease.

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Left ventricular fibrosis by extracellular volume fraction and the risk of atrial fibrillation recurrence after catheter ablation

Cardiovascular Diagnosis and Therapy ◽

10.21037/cdt.2019.12.03 ◽

2019 ◽

Vol 9 (6) ◽

pp. 578-585

Author(s):

Songnan Li ◽

Lei Zhao ◽

Xiaohai Ma ◽

Rong Bai ◽

Jie Tian ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Volume Fraction ◽

Extracellular Volume ◽

Extracellular Volume Fraction ◽

Left Ventricular ◽

Atrial Fibrillation Recurrence ◽

Ventricular Fibrosis

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Antiarrhythmische Pharmakotherapie

Nervenheilkunde ◽

10.1055/s-0038-1628228 ◽

2012 ◽

Vol 31 (11) ◽

pp. 826-829

Author(s):

A. Goette ◽

P. Kirchhof ◽

A. Treszl ◽

K. Wegscheider ◽

T. Meinertz

Keyword(s):

Atrial Fibrillation ◽

Drug Therapy ◽

Angiotensin Ii ◽

Catheter Ablation ◽

Early Treatment ◽

Stroke Prevention ◽

Conventional Treatment ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Atrial Fibrillation Trial

ZusammenfassungEs werden die Ergebnisse von Studien sowie die Protokolle laufender „Megastudien“ mit Bezug zum Vorhofflimmer-Netzwerk dargestellt. Bei den abgeschlossenen Studien handelt es sich um die Flecainide Short-Long trial (Flec-SL) und die Angiotensin-II-Rezeptorblocker in Paroxysmal Atrial FibrillationStudie (ANTIPAF). Bei den „Megastudien“ um Studien mit den Kürzeln EAST (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), CABANA (Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial) und CASTLE-AF (Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation). Die Ergebnisse der Studien: Eine präventive Kurzzeittherapie nach Kardio-version ist sinnvoller als der Verzicht auf jegliche Antiarrhythmika-Nachbehandlung. Noch effektiver scheint eine antiarrhythmische Langzeit-Nachbehandlung über sechs Monate zu sein. In der ANTIPAF-Studie zeigte sich, dass bei Patienten mit paroxysmalem Vorhofflimmern (VHF) ohne strukturelle Herzkrankheit der Angiotensinrezeptorblocker Olmesartan nicht in der Lage ist, die Häufigkeit der Anfälle zu reduzieren. Wichtigstes therapeutisches Ziel ist die Verhinderung der Progression von VHF. In der EAST-Studie wird geprüft, ob eine frühzeitig eingeleitete, „aggressive“ Therapie zur Kontrolle des Herzrhythmus eher in der Lage ist, Morbidität und Mortalität von VHF zu senken als die Standardtherapie.

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