Abstract 2156: Left Atrial Fibrosis Impacts Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Nazem W Akoum ◽  
Robert S Oakes ◽  
Yaw Adjei-Poku ◽  
Suman Kuppahally ◽  
Nathan M Segerson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Atrial Fibrosis ◽  
Ventricular Ejection Fraction ◽  
Average Improvement ◽  
Left Atrial Fibrosis

Background. The extent of left atrial (LA) wall fibrosis detected by delayed enhancement MRI (DE-MRI) appears to be correlated with advanced atrial fibrillation (AF). However, the effect of LA fibrosis on left ventricular function (LVEF) is not well understood. We report the relationship between left atrial fibrosis and LVEF in patients with AF. Methods. Sixty-seven patients underwent DE-MRI and 2-dimensional trans-thoracic echocardiography prior to ablation for AF. Three dimensional segmentation of the LA was performed and the extent of fibrosis was quantified using a semi-automated algorithm. Patients were assigned to one of three groups based on the degree of LA fibrosis; 1) mild enhancement where the fibrosis < 15% of the LA wall, 2) moderate enhancement where fibrosis > 15% and < 35%, and extensive where fibrosis > 35% of the LA wall. LVEF was determined both prior to and 3 months following pulmonary vein antrum isolation with posterior wall and septal debulking. Results. The average pre-ablation LVEF among patients with mild fibrosis was 53.2% ± 9.9% (n = 41), 52.3% ± 7.4% (n = 19) among patients with moderate fibrosis and 42.1% ± 9.9% (n = 7) among those with extensive enhancement (p = 0.01,one way ANOVA). The difference remains significant after controlling for patient age, gender, hypertension, MI, AF type, mitral valve regurgitation, CAD and the presence of non-AF related CHF. Following ablation, all groups had an increase in the LVEF. The greatest increase occurred among patients in the extensive group. On average, this group experienced an overall improvement of 10.8% ± 14.1%. Patients in the mild enhancement group had an average improvement of 3.3% ± 11.1% and those in the moderate group had an average improvement of 3.8% ± 5.6%. The post-ablation LVEF among patients with mild fibrosis was 56.6% ± 8.3%, 56.2% ± 6.4% among patients with moderate fibrosis and 53.0% ± 15.4% among patients with extensive fibrosis. Conclusion. From our preliminary experience with DE-MRI fibrosis detection, patients with extensive LA fibrosis appear to have depressed LV function pre-ablation. This group of patients seems to experience a large improvement (~11%) in LV function post-ablation compared to patients with less LA fibrosis.

Left atrial fibrosis predicts left ventricular ejection fraction response after atrial fibrillation ablation in heart failure patients: the Fibrosis-HF Study

EP Europace ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. 1812-1821
Author(s):  
Bettina Kirstein ◽  
Sebastian Neudeck ◽  
Thomas Gaspar ◽  
Judith Piorkowski ◽  
Simon Wechselberger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Atrial Fibrosis ◽  
Ventricular Ejection Fraction ◽  
Af Ablation ◽  
Left Atrial Fibrosis

Abstract Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Catheter ablation has been reported to restore left ventricular (LV) function but patients benefit differently. This study investigated the correlation between left atrial (LA) fibrosis extent and LV ejection fraction (LVEF) recovery after AF ablation. Methods and results In this study, 103 patients [64 years, 69% men, 79% persistent AF, LVEF 33% interquartile range (IQR) (25–38)] undergoing first time AF ablation were investigated. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. Continuous rhythm monitoring was used to assess ablation success. Improvement in post-ablation LVEF was measured as primary study endpoint. An absolute increase in post-ablation LVEF ≥10% was defined as ‘Super Response’. Left atrial fibrosis was present in 38% of patients. After ablation LVEF increased by absolute 15% (IQR 6–25) (P &lt; 0.001). Left ventricular ejection fraction improvement was higher in patients without LA fibrosis [15% (IQR 10–25) vs. 10% (IQR 0–20), P &lt; 0.001]. An inverse correlation between LVEF improvement and the extent of LA fibrosis was found (R2 = 0.931). In multivariate analysis, the presence of LA fibrosis was the only independent predictor for failing LVEF improvement [odds ratio 7.2 (95% confidence interval 2.2–23.4), P &lt; 0.001]. Echocardiographic ‘Super Response’ was observed in 55/64 (86%) patients without and 21/39 (54%) patients with LA fibrosis, respectively (P &lt; 0.001). Conclusion Presence and extent of LA fibrosis predict LVEF response in HF patients undergoing AF ablation. The assessment of LA fibrosis may impact prognostic stratification and clinical management in HF patients with AF.

P5651Association of left atrial fibrosis extent with left ventricular geometric remodeling and diastolic dysfunction in patients with paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Gizatulina ◽  
A V Pavlov ◽  
L U Martyanova ◽  
G V Kolunin ◽  
I V Shorochova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Low Voltage ◽  
Left Ventricular ◽  
Lv Function ◽  
Atrial Fibrosis ◽  
Concentric Hypertrophy ◽  
Eccentric Hypertrophy ◽  
Left Atrial Fibrosis

Abstract Introduction Whether left atrial fibrosis (LAf) in patients with atrial fibrillation (AF) is a consequence of left ventricular (LV) diastolic dysfunction or primary atrial pathology continues to be a debatable issue. Electroanatomical mapping (EAM) allows to image and to define LAf as a substrate of AF. Purpose To study the relationship of LAf extent with LV diastolic function and geometric remodeling in patients (pts) with paroxysmal AF. Methods 56 pts with paroxysmal AF (mean age 57.1±8.4 years, 31 males), undergone catheter ablation, were enrolled in the study, including 30 pts with arterial hypertension (AH), 15 – with coronary artery disease (CAD) and AH. Comprehensive transthoracic echocardiography was carried out in all pts to assess chamber volumes, systolic and LV diastolic functions and geometry patterns according to Recommendations of ASE and EACVI. Before ablation, EAM was performed in sinus rhythm. The bipolar low voltage areas of LAf were identified with the cut-off <0.5 mV. For the LAf quantification following indicators were calculated: total square of LAf (Sf, cm2) and LAf degree, estimated as an analog of the UTAH staging system, by selection of UTAH I: <5% fibrosis; II: 5–19%; III: 20–35% and IV: >35%. Results All patients had preserved systolic LV function. To assess the influence of LV geometry on LAf extent all pts were distributed in accordance to LV geometry patterns (p): normal geometry (pI) – 27 pts, concentric remodeling (pII) – 13, eccentric hypertrophy (pIII) – 10, concentric hypertrophy (pIV) – 6. Pts with pIII were older than pI pts: 60.8±6.4 vs 53.9±10.4 (p=0.048). All pts with pIII and pIV had AH. From 11 pts without AH, 10 had pI of LV geometry. PIII was revealed more often in CAD pts compared to those without CAD: 29.2 vs 10.5% (p=0.04). PIII pts had bigger LA volume compared to pI pts (74.3±22.5 vs 58.8±19.4 ml, p=0.019) and pII pts (61.9±14.9, p=0.05), but LA volume of pIII pts didn't differ from pIV pts (71.9±14.5, p=0.78). PIII pts had more extent Sf than pI pts (28.32±8.9 vs 13.4±6.5, p=0.05), while Sf of pII (17.3±8.7, p=0.495) and pIV pts (16.4±9.5, p=0.699) didn't differ significantly from Sf of pI pts. As for the degree of LAf, UTAH I was absent in pts with pIII and UTAH IV was revealed in 40% of these pts, while in pts with pI UTAH I was in 26% and UTAH IV - in 14.8% (p=0.049). However, Sf and UTAH degree did not depend on age, CAD and heart failure presence. As for diastolic dysfunction, in pIII and pIV pts e∼septal and e∼lateral were lower compared to pI pts: 6.3±1.9, 5.5±2.4 vs 8.5±2.2 (p<0.01) and 8.2±2.7, 8.0±3.8 vs 11.3±2.9 (p<0.01), respectively, while E/e∼ in pIII pts didn't differ from pI pts (8.0±1.6 vs 7.2±1.6, p=0.17), but in pIV was more than in pI pts (10.4±2.8, p=0.003). Conclusion LAf extent in paroxysmal AF is associated more with such LV geometry pattern as eccentric hypertrophy, than with diastolic disorders, which accompany both eccentric and concentric hypertrophy.

scholarly journals Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
E Marcusohn ◽  
O Kobo ◽  
M Postnikov ◽  
D Epstein ◽  
Y Agmon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Prosthetic Valves ◽  
Ventricular Response ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background  The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR). Aim  The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL). Methods  This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF &gt;50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded. Results From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction. Conclusion In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

scholarly journals Incidence and predictors of left atrial thrombus development in patients scheduled for repeat catheter ablation for atrial fibrillation: Is transesophageal echocardiography always mandatory?

2021 ◽  
Author(s):  
Satoshi Yanagisawa ◽  
Yasuya Inden ◽  
Shuro Riku ◽  
Kazumasa Suga ◽  
Koichi Furui ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Imaging Modality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Imaging Evaluation ◽  
Ventricular Ejection Fraction

Introduction: The risk of developing left atrial (LA) thrombi after initial catheter ablation for atrial fibrillation (AF) and requirements for imaging evaluation for thrombi screening at repeat ablation is unclear. This study aimed to assess the occurrence of thrombus development and frequency of any imaging study evaluating thrombus formation during repeat ablation for AF. Methods: Of 2,066 patients undergoing initial catheter ablation for AF with uninterrupted oral anticoagulation, 615 patients underwent repeat ablation after 258.0 (105.0-882.0) days. We investigated which factors were associated with safety outcomes and requirements for thrombi screening. Results: All patients underwent at least one imaging examination to screen for thrombi in the first session, but the examination rate decreased to 476 patients (77%) before the repeat procedure. The frequency of imaging evaluations was 5.0%, 11%, 21%, 84%, and 91% for transesophageal echocardiography and 18%, 33%, 49%, 98%, and 99% for any imaging modality at repeat ablation performed ≤60 days, ≤90 days, ≤180 days, >180 days, and >1 year after the initial procedure, respectively. Three patients (0.5%) developed LA thrombi at repeat ablation due to identifiable causes, and no patients had thromboembolic events when no imaging evaluation was performed. Multivariate analysis revealed that repeat ablation >180 days, non-paroxysmal atrial arrhythmias, and lower left ventricular ejection fraction were predictors of the risk of thrombus development. Conclusions: The risk development of thrombus at repeat ablation for AF was low. There needs to be a risk stratification for the requirement of imaging screening for thrombi at repeat ablation for AF.

scholarly journals HOLTER MONITORING AND ECHOCARDIOGRAPHY FOR PREDICTING THE EFFECTIVENESS OF PULMONARY VIEN ISOLATION IN PATIENTS WITH PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION

2018 ◽  
Vol 7 (3) ◽  
pp. 12-23
Author(s):  
A. V. Tregubov ◽  
Yu. V. Shubik
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Size ◽  
Ventricular Ejection Fraction ◽  
Atrial Size ◽  
The Impact

Aim. To evaluate the impact of the atrial ectopic activity and left ventricular diastolic dysfunction on predicting the effectiveness of pulmonary vein isolation (PVI) in patients with paroxysmal and persistent atrial fibrillation (AF).Methods. 54 patients with paroxysmal and persistent AF and the normal left ventricular ejection fraction were included in the study. Patients underwent Holter monitoring and echocardiography prior to the intervention to identify the predictors of successful PVI. The follow-up was 12 months after the indexed procedure. The effectiveness of treatment was assessed from the third month of the postoperative period. The criterion of the successful treatment was the absence of the AF paroxysms lasting more than 30 seconds, confirmed by Holter, diurnal and / or multi-day monitoring. The Student's t-test was used to assess the reliability of the differences between the variables characterizing the treatment results in the study groups. The discriminant analysis was performed to develop an algorithm that allows predicting the PVI result. A p value <0.05 was considered statistically significant.Results. Premature atrial contraction over 70 per hour can be considered as the predictor of the successful PVI in patients with normal left atrial size. The severe LA enlargement should be considered as a predictor of poor ablation efficacy. The obtained discriminant function allows predicting the effectiveness of PVI in patients with paroxysmal and persistent AF depending on Holter monitoring and echocardiography. Its sensitivity is high for both predicting success and failure of the intervention.Conclusion. Holter monitoring and echocardiography allow predicting the effectiveness of PVI. The intervention's efficacy in the groups of patients with severe LA enlargement and the combination of normal left atrial size with over 70 PAC per hour should be addressed in the further studies.

P3764Morphological mechanisms of atrial functional mitral regurgitation in patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Nagaoka ◽  
Y Mukai ◽  
S Kawai ◽  
S Takase ◽  
K Sakamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Ventricular Ejection Fraction

Abstract Background Atrial functional mitral regurgitation (AFMR) occurs in patients with atrial fibrillation. However, morphological mechanisms of AFMR are poorly understood. Purpose The purpose of this study was to examine the morphological characteristics in patients with AFMR. Methods Among consecutive 795 patients undergoing initial radiofrequency catheter ablation (RFCA) at our hospital, twenty-five patients with persistent AF accompanied by AFMR (≥ moderate) before RFCA (AFMR group) were studied. Age-matched 25 patients with persistent AF without MR were defined as a control group. Results Left ventricular ejection fraction (LVEF) was lower and left atrium volume index was larger in the AFMR group (Table). Mitral valve annulus diameter and length of anterior mitral leaflet (AML) were similar between groups, whereas length of posterior mitral leaflet (PML) was significantly shorter in the AFMR group. Smaller tethering angle of AML (γ in the figure) and shorter tethering height were significantly associated with the occurrence of AFMR, which were different from morphology of functional mitral regurgitation in patients with dilated LV. Multiple regression analysis revealed that less tenting height (p<0.05) and LA dilatation toward the posterior (p<0.01) were significantly related to AFMR. Echocardiographic parameters AFMR (n=25) Control (n=25) P value Age, y 69±8 66±10 NS Male, n (%) 9 (36) 20 (80) P=0.001 LVEF,% 60±9 67±6 P=0.004 LAD, mm 44±5 41±7 NS LAVI, ml/m2 56±17 41±13 P<0.001 MV diameter, mm 3.9±0.4 3.8±0.5 NS α angle, ° 34±9 35±7 NS β angle, ° 48±9 50±8 NS γ angle, ° 32±5 37±5 P=0.0005 AML length, mm 3.0±0.5 3.0±0.5 NS PML length, mm 2.1±0.1 2.4±0.1 P=0.03 Tenting height, mm 1.5±0.1 1.8±0.1 P=0.02 D, mm 0.8±0.3 0.5±0.3 P=0.001 LVEF: left ventricular ejection fraction; LAD: left atrial diameter; LAVI: left atrial volume index; AML: anterior mitral leaflet; PML: posterior mitral leaftlet. Conclusions AFMR occurs in patients with unique morphological features, such as less tethering height and LA dilatation toward the posterior.

scholarly journals ASSOCIATION OF LEFT ATRIAL FIBROSIS EXTENT WITH LEFT VENTRICULAR STRUCTURAL AND FUNCTIONAL REMODELLING IN PATIENTS WITH ATRIAL FIBRILLATION

2019 ◽  
Vol 34 (2) ◽  
pp. 39-46
Author(s):  
T. P. Gizatulina ◽  
A. V. Pavlov ◽  
L. U. Martyanova ◽  
I. V. Shorokhova ◽  
G. V. Kolunin
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Low Voltage ◽  
Negative Relationship ◽  
Left Ventricular ◽  
Lv Function ◽  
Nonvalvular Atrial Fibrillation ◽  
Concentric Hypertrophy ◽  
Eccentric Hypertrophy ◽  
Left Atrial Fibrosis

Aim.To investigate the relationships between left atrial (LA) fibrosis extent and left ventricular (LV) structural and functional status in patients (pts) with nonvalvular atrial fibrillation (AF).Material and Methods.The study enrolled 56 pts (mean age 57.1±8.4 years, 25 females), admitted to hospital for primary catheter ablation (CA), including 47 pts with paroxysmal AF and 9 pts with persistent AF. All pts had scheduled transthoracic echocardiography to measure size and volume of cardiac chambers and systolic and diastolic functions of the left ventricle. Based on the calculation of the LV mass index (LVMI) and relative wall thickness (RWT), we categorized all pts into 4 groups: (1) normal geometry (n=27); (2) concentric remodeling (normal LVMI and high RWT, n=13); (3) concentric hypertrophy (high LVMI and high RWT, n=6); and (4) eccentric remodeling (high LVMI and normal RWT, n=10). The assessment of LA fibrosis sizes was based on the allocation of low voltage zones (<0.5 mV) in the process of voltage electroanatomic mapping (VEM) as the first stage of CA. Following indicators were calculated: total square of fibrosis (Sf), % of fibrosis from the total LA square (Sf%), the degree of LA fibrosis (an analog of the UTAH score), and number of LA fibrosis zones. Level of NT-proBNP in blood was determined among other laboratory tests. All pts had preserved LV ejection fraction (LVEF).Results.Results of the study confirmed positive relationships between Sf, Sf% and LA diameter, LVMI, and NT-proBNP level. Negative relationship was noted between Sf, Sf%, the UTAH degree and LVEF. Such LV geometry type as eccentric hypertrophy was associated with a higher number of LA fibrosis zones compared to the normal LV geometry, while significant differences in other types of geometry were not found.Conclusion. Thus, LA fibrosis extent was associated with LA size, LV function, and LV geometric remodeling pattern.

scholarly journals THE PREDICTION OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION

2013 ◽  
Vol 68 (11) ◽  
pp. 26-29
Author(s):  
N. E. Grigoriadi ◽  
L. M. Vasilets ◽  
A. V. Tuev ◽  
E. A. Ratanova ◽  
O. V. Khlynova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Body Surface ◽  
Left Atrial ◽  
Prognostic Value ◽  
Left Ventricular ◽  
The Body ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Aim. To study the parameters of the structural and functional state of the myocardium in patients with hypertension, to determine their prognostic value on the risk of atrial fibrillation (AF). Patients and methods: the study involved 72 people: patients with hypertension and AF, with isolated hypertension and apparently healthy individuals. All of them performed echocardiography, blood pressure monitoring and monitoring of cardiogram. Results: the dilatation of left atrial was founded: patients with the atrial fibrillation on the background of hypertension observed the most pronounced changes in the left atrial. In patients with hypertension without arrhythmias and in combination with atrial fibrillation severe left ventricular hypertrophy was observed. Left ventricle systolic function in groups has been stored but in patients with atrial fibrillation on the background of hypertension was significantly lower. The risk of atrial fibrillation in patients with hypertension prognostic value are the only values of the age, the volume index of the left atrial to the body surface area and left ventricular ejection fraction. Conclusions. The risk of AF in hypertension occurs over the age of 55 and each subsequent year increases it in 1,2 times,  it increases with an index value of the left atrial to the body surface over 29 ml/m2 and with a decrease in left ventricular ejection fraction less than 58%. 

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