Abstract 18601: Impact of Right and Left Atrial Remodeling on Outcomes From Atrial Fibrillation Rotor Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amir Schricker ◽  
Tina Baykaner ◽  
Junaid Zaman ◽  
Gautam Lalani ◽  
Kenneth Hopper ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Structural Changes ◽  
Unknown Etiology ◽  
Atrial Remodeling ◽  
Left Atrial Remodeling ◽  
Single Procedure ◽  
Clinical Indices ◽  
The Right

Introduction: Targets for the ablation of atrial fibrillation (AF) are debated. In particular, recent studies questioning fractionated electrograms and lines has increased focus on AF substrates of rotors and focal impulses. These AF sources are seen in both atria, but have unknown etiology. We hypothesized that differential remodeling between the right atrium (RA), whose structural changes are largely undefined, and left atrium (LA) influence the distribution of AF sources and the outcomes from AF source ablation. Methods: In 60 patients at AF ablation (62±10 years, 60% persistent, 5% long-standing persistent), we compared size differences between RA and LA to the number of sources in each chamber and outcomes from AF source-guide ablation. We studied if a 64-pole basket differentially fit the LA or RA, judged by deformation of its splines by the atria (fig. A, B) over multiple cardiac cycles on fluoroscopy. Ablation targeted sources in both atria and was followed by PVI, with follow-up per guidelines. Results: Using baskets in both atria, 205 sources (LA 138; RA 67) were identified and ablated. Notably, the same basket in each patient was dynamically deformed by RA in 51 (85%) of cases but in the LA in only 39 (65%), indicating greater LA remodeling. The number of AF sources was higher in the presence of basket deformation of RA (n=174) than LA (n=130). LA deformation correlated with LVEF (p=0.05). Freedom from AF at 1 year was reduced in patients with no basket deformation (i.e. dilation) in LA (p=0.07) or RA (p=0.06). Notably, single procedure AF freedom was substantially lower in patients with differential remodeling (deformation in only 1 chamber) of 84% vs. 60% (fig C). Conclusions: Structural atrial remodeling influences the number of electrical rotors and focal sources in each chamber. A mismatch between right and left atrial remodeling predicts lower success from rotor ablation. These data also provide novel clinical indices of effective basket positioning.

scholarly journals Echocardiography in Patients with Atrial Fibrillation - What Should the Internist Doctor Know?

2020 ◽  
Vol 17 (4) ◽  
pp. 49-60
Author(s):  
Maria-Luiza Toplicianu-Dimitriu ◽  
Ioan Tiberiu Nanea
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Structural Changes ◽  
Excess Mortality ◽  
Ventricular Dysfunction ◽  
Imaging Technique ◽  
Left Ventricular ◽  
Clinical Impact ◽  
Atrial Remodeling ◽  
Routine Imaging

AbstractAtrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing prevalence and an enormous clinical impact due to the high stroke rate, left ventricular dysfunction and excess mortality. The occurrence and maintenance of AF is favored by both the degree of left atrial (LA) dilation and the association of fibrotic lesions of the myocardium. The LA is a marker of adverse cardiovascular events in patients with AF. Atrial remodeling can be electrical (shortening atrial refractory), structural (altering geometry and altering collagen content) and contractile (loss of contractility). Cardiac imaging plays a central role in the clinical management of this arrhythmia. Echocardiography represents the routine imaging technique used in patients with AF, with a role in detecting LA dysfunction and cardiac structural changes that predispose to this arrhythmia, also having the ability to predict the maintenance of sinus rhythm after cardioversion and after ablation.

Abstract 3175: Plasma Tansforming Growth Factor Beta as a Biochemical Marker to Predict the Recurrence of Atrial Fibrillation After Surgical Maze

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Young Keun On ◽  
Dae-Hee Shin ◽  
Jin-Oh Choi ◽  
Yong Hwan Park ◽  
Sang Yeub Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Messenger Rna ◽  
Left Atrial ◽  
Multiple Logistic Regression Analysis ◽  
Internal Standard ◽  
Maze Procedure ◽  
Atrial Remodeling ◽  
Rt Pcr ◽  
Heart Operation

BACKGROUND Atrial remodeling leads to perpetuation of atrial fibrillation (AF). Structural remodeling in the form of fibrosis alters the substrate. The surgical Maze procedure was developed as a surgical treatment of AF. Our purpose was to evaluate the role of plasma NT-proBNP, hsCRP, TIMP-1(Tissue inhibitors of MetalloProteinase-1), TGF-β, MMP-3(Matrix MetalloProteinase-3), and pro-MMP-1in predicting the recurrence of AF after surgical Maze procedure. And we also evaluated the association of expression of CTGF, TGF-β, BNP, ANP, collagen-1α, and collagen-3α in LA with the recurrence of AF after surgical Maze procedure. METHODS Preoperative plasma NT-proBNP, hsCRP, TIMP, TGF-β, MMP-3, and pro-MMP-1 levels were measured in consecutive 86 patients (age 54±12 yrs) who underwent the open heart operation for valvular heart disease and surgical Maze procedure for AF. Moreover, we performed molecular examinations of CTGF, TGF-β, BNP, ANP, Collagen-1α, Collagen-3α in the resected left atrial tissues. Symptomatic AF documented by ECG or an episode of AF revealed at follow-up holter monitoring were considered atrial fibrillation recurrences. RESULTS At 1-year follow-up, 10 among 86 patients had persistence of AF. Patients with AF persistence had higher plasma TGF-β levels than the patients with sinus rhythm (0.44 ± 0.29 vs 0.32 ± 0.15 ng/ml) . Patients with AF persistence had higher messenger RNA expressions of Collagen-3α (0.21 ± 0.20 vs 0.12 ± 0.12, compared with internal standard GAPDH by RT-PCR) and lower messenger RNA expressions of ANP (0.31 ± 0.16 vs 0.60 ± 0.76, compared with internal standard GAPDH by RT-PCR ) in left atrial tissues. Multiple logistic regression analysis revealed that plasma TGF-β was independently associated with postoperative persistence of atrial fibrillation at 1 year follow-up after surgical Maze procedure. CONCLUSIONS Advanced atrial degenerative change might result in a decrease of atrial ANP secretion. Cardiac fibrosis might be a determinant of myocardial heterogeneity and the persistence of AF. Plasma TGF-β could predict the persistence of AF at 1 year follow-up after surgical Maze procedure.

scholarly journals Left Atrial Remodeling and Response to Valsartan in the Prevention of Recurrent Atrial Fibrillation

2011 ◽  
Vol 4 (6) ◽  
pp. 721-728 ◽  
Author(s):  
Lidia Staszewsky ◽  
Maylene Wong ◽  
Serge Masson ◽  
Elena Raimondi ◽  
Silvana Gramenzi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Remodeling ◽  
Left Atrial Remodeling ◽  
Recurrent Atrial Fibrillation
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