Abstract 10199: Right Atrial Fibrillation in Humans - Evidence for A Right Atrial Driver Activated by Right Atrial Ectopies

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hideyuki Hasebe ◽  
Kentaro Yoshida ◽  
Masataka Iida ◽  
Naoki Hatano ◽  
Toshiro Muramatsu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Spectral Analysis ◽  
Family History ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Volume Ratio ◽  
Dominant Frequency ◽  
Right Atrial ◽  
History Of ◽  
Atrial Ectopy

Background: A left-to-right dominant frequency (DF) gradient exists in acute atrial fibrillation (AF) in animals and in paroxysmal AF (PAF) in humans. PAF initiated by right atrial ectopy (PAF-RAE) is rare. Adenosine triphosphate (ATP) can be effective to unmask such a rare non-pulmonary vein (PV) ectopy and accelerate the frequency of a reentrant source of AF (driver). Objective: This study aimed to investigate characteristics of patients with PAF-RAE using pharmacological maneuvers and spectral analysis. Methods: Enrolled were 111 consecutive patients referred for catheter ablation of lone PAF. Infusions of isoproterenol and ATP were used to induce AF. Patients with PAF initiated only by PV ectopies and with PAF-RAE were classified into the PV-ectopy group (N=32) and RA-ectopy group (N=6), respectively. ATP was also injected during ongoing AF to unmask the AF driver. High RA, coronary sinus (CS), and PV-left atrial junction (PV-LAJ) electrograms underwent spectral analyses. Results: RA-ectopy group patients were younger (49±13 vs. 63±7 years, p<0.001), more commonly had a family history of AF (67% vs. 9%, p<0.001), and had a higher RA appendage/RA volume ratio (0.22±0.022 vs. 0.15±0.055, p=0.002) than PV-ectopygroup patients. The most common origin of RA ectopy was the base of the RA appendage (67%). There was a baseline right-to-left DF gradient in the RA-ectopy group (PV-LAJ: 6.0±0.4, CS: 5.7±0.7, RA: 7.4±0.8 Hz, p<0.05), in contrast to a left-to-right DF gradient in the PV-ectopy group (PV-LAJ: 5.9±0.8, CS: 5.3±0.7, RA: 5.2±0.8 Hz, p<0.01). ATP injection mainly increased the DF of the high RA, augmenting a right-to-left DF gradient in the RA ectopy group (PV-LAJ: 8.0±2.0, CS: 7.8±1.0, RA: 10.7±0.7 Hz, p<0.05), whereas it augmented a left-to-right DF gradient in the PV-ectopy group (PV-LAJ: 7.9±1.0, CS: 6.4±0.5, RA: 6.6±1.2 Hz, p<0.05). Conclusions: PAF-RAE may be maintained by a reentrant driver localized in the RA (so-called right atrial fibrillation).

scholarly journals The Association of Pre-Existing Left Atrial Fibrosis with Clinical Variables in Patients Referred for Catheter Ablation of Atrial Fibrillation

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15036 ◽  
Author(s):  
Jane Dewire ◽  
Irfan M. Khurram ◽  
Farhad Pashakhanloo ◽  
David Spragg ◽  
Joseph E. Marine ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Af Ablation ◽  
Group 4 ◽  
Significant Difference ◽  
History Of ◽  
Group 2 ◽  
Magnetic Resonance Imaging Mri ◽  
Left Atrial Fibrosis

Introduction Atrial fibrillation (AF) recurrence after ablation is associated with left atrial (LA) fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI). We sought to determine pre-ablation, clinical characteristics that associate with the extent of LA fibrosis in patients undergoing catheter ablation for AF. Methods and Results Consecutive patients presenting for catheter ablation of AF were enrolled and underwent LGE-MRI prior to initial AF ablation. The extent of fibrosis as a percentage of total LA myocardium was calculated in all patients prior to ablation. The cohort was divided into quartiles based on the percentage of fibrosis. Of 60 patients enrolled in the cohort, 13 had <5% fibrosis (Group 1), 15 had 5-7% fibrosis (Group 2), 17 had 8-13% fibrosis (Group 3), and 15 had 14-36% fibrosis (Group 4). The extent of LA fibrosis was positively associated with time in continuous AF, and the presence of persistent or longstanding persistent AF. However, no statistically significant difference was observed in the presence of comorbid conditions, age, BMI, LA volume, or family history of AF among the four groups. After adjusting for diabetes and hypertension in a multivariable linear regression model, paroxysmal AF remained independently and negatively associated with the extent of fibrosis (-4.0 ± 1.8, P = 0.034). Conclusion The extent of LA fibrosis in patients undergoing AF ablation is associated with AF type and time in continuous AF. Our results suggest that the presence and duration of AF are primary determinants of increased atrial LGE.

Abstract 4104: Organization of Atrial Signals is Critical Prior to Cardioversion of Atrial Fibrillation with Intravenous Flecainide: Insight from Spectral Analysis of Intracardiac Electrograms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jiun Tuan ◽  
Suman Kundu ◽  
Mohamed Jeilan ◽  
Faizel Osman ◽  
Rajkumar Mantravadi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Spectral Analysis ◽  
Catheter Ablation ◽  
Cycle Length ◽  
Dominant Frequency ◽  
Relative Increase ◽  
Significant Difference ◽  
Before And After ◽  
Atrial Activation ◽  
Relative Change

Introduction & Hypothesis: Studies in catheter ablation of atrial fibrillation (AF) show that an increase in cycle length (CL) and higher organization index (OI) is associated with termination of AF. We hypothesize that similar changes can be seen in chemical cardioversion with Flecainide Methods: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. OI and dominant frequency (DF) were obtained by Fast Fourier Transform of coronary sinus electrograms over 10s in AF, before and after flecainide infusion. Mean CL was also calculated. Results: 28 patients were identified (18 paroxysmal AF and 10 persistent AF). 8 cardioverted to sinus rhythm (SR) with flecainide. In all patients, mean CL increased from 211 ± 44 ms to 321 ± 85 ms (p <0.001). Mean DF decreased from 5.2 ± 1.03 Hz to 3.6 ± 1.04 Hz (p <0.001). Mean OI was 0.33 ± 0.13 before and 0.32 ± 0.11 after flecainide (p = 0.90). Comparing patients who cardioverted to SR with those who did not, OI post-flecainide was 0.41 ± 0.12 vs 0.29 ± 0.10 (p=0.013) and relative change in OI was 29 ± 33% vs −3.9 ± 27% (p=0.016) respectively. No significant difference was noted in the change in CL and DF in the 2 groups. Logistic regression showed that a greater relative increase in OI (p=0.04), a higher OI post-flecainide (p=0.03) and SR at start of procedure (p=0.03) are independently associated with cardioversion to SR with flecainide. Conclusion: Increase in OI, independent of changes to the CL and DF, appears critical to AF termination with flecainide. The increase in OI may reflect an increase in size and reduction in the number of re-entrant circuits, which together with slowing of atrial activation, result in return to SR.

Noncontact Mapping-Guided Catheter Ablation of Atrial Fibrillation Associated with Left Atrial Ectopy

2000 ◽  
Vol 11 (4) ◽  
pp. 475-479 ◽  
Author(s):  
MICHAEL A.E. SCHNEIDER ◽  
GJIN NDREPEPA ◽  
BERNHARD ZRENNER ◽  
MARTIN R. KARCH ◽  
JUERGEN SCHREIECK ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Noncontact Mapping ◽  
Atrial Ectopy

scholarly journals Family history of atrial fibrillation as a predictor of atrial substrate and arrhythmia recurrence in patients undergoing atrial fibrillation catheter ablation

EP Europace ◽  
2017 ◽  
Vol 20 (6) ◽  
pp. 921-928 ◽  
Author(s):  
Sunil Kapur ◽  
Saurabh Kumar ◽  
Roy M John ◽  
William G Stevenson ◽  
Usha B Tedrow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Family History ◽  
Catheter Ablation ◽  
History Of

scholarly journals Atrial Flutter, Typical and Atypical: A Review

2017 ◽  
Vol 6 (2) ◽  
pp. 55 ◽  
Author(s):  
Francisco G Cosío ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Catheter Ablation ◽  
Therapeutic Option ◽  
Vena Cava ◽  
Right Atrial ◽  
Clinical Electrophysiology ◽  
Electrophysiological Studies ◽  
History Of

Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

P660The effect of hypertension and metabolic syndrome on left atrial function in patients with paroxysmal atrial fibrillation undergoing catheter ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
Z Balogh ◽  
E Stefanidis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Metabolic Syndrome ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Contractile Function ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Hypertensive Patients ◽  
History Of

Abstract Background Hypertension and metabolic risk factors are associated with increased risk of atrial fibrillation (AF) and heart failure. Previous studies assessing the efficacy of catheter ablation in patients with metabolic syndrome have shown conflicting data. Purpose We thought to assess the impact of hypertension and other metabolic risk factors on left atrial (LA) phasic function in patients with paroxysmal AF undergoing the first catheter ablation. Methods We prospectively enrolled 112 consecutive patients (age: 63±21 years; 32% female) with symptomatic paroxysmal AF and preserved left ventricular ejection fraction (≥50%) undergoing the first catheter ablation during sinus rhythm, and 23 healthy controls. Patients with valvular AF or in AF at the time of ablation were excluded. All patients underwent comprehensive echocardiography at one day pre and at one day post ablation, and after three months. The LA reservoir, conduit and contractile strain and strain rate (SR) were assessed using the two-dimensional speckle tracking echocardiography as average of segmental values in apical views. Results A total of 51 (45.5%) patients had history of treated hypertension while 61 (54.5%) patients had normal arterial blood pressure, and 27 (24.1%) patients of hypertensive group and 17 (15.1%) patients of normotensive group have dyslipidemia and/or diabetes. All groups of patients had been adjusted by age and sex. Pre-ablation, hypertensive patients with metabolic risk factors showed significantly lower magnitude of reservoir and contractile strain and SR compared with other groups of patients (all p<0.05). Hypertensive patients compared with normotensive patients had significantly increase in LA volume index (39±1% vs. 34±7%, p: 0.01) and decrease in LA emptying fraction (49.5±11% vs. 54.8±9.8%, p: 0.02). Post-ablation, LA strain and SR significantly decreased in all patients regardless of the history of hypertension or other metabolic risk factors (all p<0.05). At three-month follow-up, LA strain and SR showed almost complete recovery to pre-ablation values in both groups of patients. Yet, LA function in groups of patients with metabolic risk factors remained lower compared with individuals without risk factors. Of note, hypertensive individuals showed similar improvement of LA contractile function to normotensive patients (p: 0.4) but LA reservoir function remained to be lower (p<0.05) (figure 1,2). The intra- and the inter-observer variability for the LAS and LASR assessment were below 5% and significantly lower (p<0.05) than that of the conventional LA indices. Conclusion Both reservoir and contractile LA strain are simultaneously affected by dyslipidemia and/or diabetes. LA reservoir function is affected earlier in hypertensive patients than contractile function. Reservoir LA strain appears to be the most useful parameter to monitor LA function in hypertensive patients with/without metabolic risk factors.

scholarly journals Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Mina M. Benjamin ◽  
Naeem Moulki ◽  
Aneeq Waqar ◽  
Harish Ravipati ◽  
Nancy Schoenecker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Magnetic Resonance ◽  
Catheter Ablation ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Right Atrial ◽  
Volume Index ◽  
Computer Assisted ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function. We sought to investigate the relationship of anatomical and functional parameters obtained by cardiovascular magnetic resonance (CMR), with AF recurrence in paroxysmal AF (pAF) patients after catheter ablation. Methods We studied 80 consecutive pAF patients referred for ablation, between January 2014 and December 2019, who underwent pre- and post-ablation CMR while in sinus rhythm. LA volumes were measured using the area–length method and included maximum, minimum, and pre-atrial-contraction volumes. CMR-derived LA reservoir strain (ℇR), conduit strain (ℇCD), and contractile strain (ℇCT) were measured by computer assisted manual planimetry. We used a multivariate logistical regression to estimate the independent predictors of AF recurrence after ablation. Results Mean age was 58.6 ± 9.4 years, 75% men, mean CHA2DS2-VASc score was 1.7, 36% had prior cardioversion and 51% were taking antiarrhythmic drugs. Patients were followed for a median of 4 years (Q1–Q3 = 2.5–6.2 years). Of the 80 patients, 21 (26.3%) patients had AF recurrence after ablation. There were no significant differences between AF recurrence vs. no recurrence groups in age, gender, CHA2DS2-VASc score, or baseline comorbidities. At baseline, patients with AF recurrence compared to without recurrence had lower LV end systolic volume index (32 ± 7 vs 37 ± 11 mL/m2; p = 0.045) and lower ℇCT (7.1 ± 4.6 vs 9.1 ± 3.7; p = 0.05). Post-ablation, patients with AF recurrence had higher LA minimum volume (68 ± 32 vs 55 ± 23; p = 0.05), right atrial volume index (62 ± 20 vs 52 ± 19 mL/m2; p = 0.04) and lower LA active ejection fraction (24 ± 8 vs 29 ± 11; p = 0.05), LA total ejection fraction (39 ± 14 vs 46 ± 12; p = 0.02), LA expansion index (73.6 ± 37.5 vs 94.7 ± 37.1; p = 0.03) and ℇCT (6.2 ± 2.9 vs 7.3 ± 1.7; p = 0.04). Adjusting for clinical variables in the multivariate logistic regression model, post-ablation minimum LA volume (OR 1.09; CI 1.02–1.16), LA expansion index (OR 0.98; CI 0.96–0.99), and baseline ℇR (OR 0.92; CI 0.85–0.99) were independently associated with AF recurrence. Conclusion Significant changes in LA volumes and strain parameters occur after AF ablation. CMR derived baseline ℇR, post-ablation minimum LAV, and expansion index are independently associated with AF recurrence.

scholarly journals Atrial Flutter, Typical and Atypical: A Review

2017 ◽  
Vol 6 (2) ◽  
pp. 55 ◽  
Author(s):  
Francisco G Cosío ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Catheter Ablation ◽  
Therapeutic Option ◽  
Vena Cava ◽  
Right Atrial ◽  
Clinical Electrophysiology ◽  
Electrophysiological Studies ◽  
History Of

Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

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