scholarly journals Left Atrial Isolation and Appendage Occlusion in Patients with Atrial Fibrillation at End Stage Left Atrial Fibrotic Disease

2021 ◽  
Author(s):  
Angela Zedda ◽  
Yan Huo ◽  
Mads Kronborg ◽  
Stefan Ulbrich ◽  
Julia Mayer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Risk Control ◽  
Right Atrial ◽  
Treatment Concept ◽  
Transport Function ◽  
Fibrotic Disease ◽  
End Stage

Background - Atrial fibrillation (AF) ablation in an end-stage left atrial (LA) fibrotic disease is more complex, has more recurrences and may compromise transport function and stroke risk. We explored whether a total left atrial isolation procedure (TLAI) followed by left atrial appendage occlusion (LAAO) is a feasible treatment concept for rhythm and stroke risk control. Methods - Symptomatic AF patients with extended LA fibrosis were enrolled consecutively for TLAI followed by LAAO. At enrollment all patients received a sinus rhythm LA voltage map. For TLAI, LA anterior and paraseptal ablation lines were placed, combined with right atrial and epicardial line completion and right pulmonary vein isolation - as needed. Rhythm follow-up was provided through continuous monitoring using implantable cardiac devices. Results - 92 patients (71±9y, 41% male, 84% persistent AF, CHA 2 DS 2 -VASc 4) underwent 104 ablation procedures. Follow-up duration measured 48±22 months. At 12-month follow-up 70 out of 92 (76%) patients were free from any atrial arrhythmia recurrence, off antiarrhythmic drugs. All intended LAAO procedures were successfully performed 6-8 weeks after TLAI. Combination of TLAI and LAAO attenuated the native 4% annual stroke risk to <1% over the entire course of the study. Patients' clinical AF and heart failure symptoms (EHRA and NYHA classification) significantly improved and remained stable during further follow-up. Invasive hemodynamic assessment as well as echocardiographic transport function analysis did not show evidence of detrimental hemodynamic effects of the treatment concept. Conclusions - This is the first report on a structured concept of interventional electrical LA isolation and LA appendage occlusion for rhythm and stroke risk control in AF patients at an end-stage left atrial fibrotic disease. We report feasibility, safety, and efficacy of such a treatment approach.

P3761Correlation between CHA2DS2-VASc score and left atrial size in patients with atrial fibrillation: an upto 15-year prospective follow-up study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T T L Lin ◽  
L Y Lin ◽  
C T T Tsai
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Cox Model ◽  
Univariate Analysis ◽  
P Value ◽  
Left Atrial Size ◽  
Positive Correlation ◽  
Atrial Size

Abstract Background Left atrial (LA) size represents atrial fibrillation (AF) burden and a predictor of AF-related stroke. CHA2DS2-VASc score is also a well-established predictor of AF-related stroke. It is unknown whether these two factors are correlated and complimentary to each other, or one of them is a major determinant of stroke risk for AF patients. Methods A total of 708 patients from the National Taiwan University AF Registry were followed upto 15 years. LA size was measured by M-mode of echocardiography and the CHA2DS2-VASc score was calculated as measures of stroke risk. Primary endpoints during follow-up were defined as ischemic strokes or transient ischemic accidents. Results Both LA size and CHA2DS2-VASc score were associated with the risk of stroke in univariate analyses (c statistic 0.662 [0.601 to 0.723] for CHA2DS2-VASc score and 0.595 [0.516 to 0.674] for LA size). There was a positive correlation between LA size and CHA2DS2-VASc score (r=0.17, P<0.0001). Patients with higher CHA2DS2-VASc scores had a higher mean LA size (P<0.01 for trend). When combining LA size and CHA2DS2-VASc score in the multivariate Cox model, only CHA2DS2-VASc score remained statistically significant to predict the thromboembolic endpoint (hazard ratio 1.39 [1.20–1.63]; P<0.001). Mode of anlysis Harzard ratio (95% confidence interval) P value Univariate analysis*   CHADS2-VASc score 1.42 (1.22–1.66) <0.001   Left Atrial Size 1.30 (1.04–1.62) 0.019 Multivariate analysis*   CHADS2-VASc score 1.39 (1.20–1.63) <0.001   Left atrial size 1.20 (0.96–1.48) 0.106 Conclusion There is a positive correlation between echocardiographic LA size and CHA2DS2-VASc score. LA size is not an independent predictor of AF-related stroke, but provides a diagnostic value to predict stroke risk through its association with CHA2DS2-VASc score. Calculation of CHA2DS2-VASc score may replace measurement of echocardiographic LA size when evaluating the risk of AF-related stroke.

Left and right atrial transport function after the maze procedure for atrial fibrillation: An echocardiographic Doppler follow-up study

1997 ◽  
Vol 10 (9) ◽  
pp. 937-945 ◽  
Author(s):  
Abdulhay Albirini ◽  
Gregory M. Scalia ◽  
R. Daniel Murray ◽  
Mina K. Chung ◽  
Patrick M. McCarthy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Maze Procedure ◽  
Right Atrial ◽  
Transport Function ◽  
Follow Up Study ◽  
Left And Right

scholarly journals Atrial fibrillation progression risk factors and associated cardiovascular outcome in well-phenotyped patients: data from the AF-RISK study

EP Europace ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 352-360 ◽  
Author(s):  
Ruben R De With ◽  
Ernaldo G Marcos ◽  
Elton A M P Dudink ◽  
Henri M Spronk ◽  
Harry J G M Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Standard Deviation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Plasminogen Activator Inhibitor 1 ◽  
Atrial Volume ◽  
Standard Deviation Increase ◽  
Recent Onset ◽  
Pai 1

Abstract Aims Atrial fibrillation (AF) is a progressive disease, but identifying patients at risk for AF progression is challenging. We aimed to identify factors associated with AF progression. Methods and results Atrial fibrillation progression was assessed in 392 patients with recent-onset paroxysmal or persistent AF included in the prospective, observational, multicentre identification of a risk profile to guide atrial fibrillation (AF-RISK) study. Progression of AF was assessed by Holter monitoring and 2-week event recorder at baseline and 1-year follow-up. AF progression was defined as: (i) doubling in AF burden at 1 year compared to baseline with a minimum AF burden of 10% in paroxysmal AF; or (ii) transition from paroxysmal to persistent or permanent AF; or (iii) persistent to permanent AF. Age was 60 ± 11 years, 62% were men, and 83% had paroxysmal AF. At 1 year, 52 (13%) had AF progression (11% in paroxysmal; 26% in persistent AF). Multivariable logistic regression showed that left atrial volume [odds ratio (OR) per 10 mL 1.251, 95% confidence interval (CI) 1.078–1.450; P &lt; 0.001], N-terminal pro-B-type natriuretic peptide (NT-proBNP; OR per standard deviation increase 1.583, 95% CI 1.099–2.281; P = 0.014), and plasminogen activator inhibitor-1 (PAI-1; OR per standard deviation increase 0.660, 95% CI 0.472–0.921; P = 0.015) were associated with AF progression. In an additional follow-up of 1.9 (0.9–3.3) years patients with AF progression developed more cardiovascular events and all-cause mortality (12.4%/year vs. 2.3%/year, P &lt; 0.001). Conclusion Atrial fibrillation progression occurred in 13% of patients with recent-onset AF during 1-year follow-up. Left atrial volume, NT-proBNP, and PAI-1 were associated with AF progression. Patients with AF progression had a higher event rate. Trial registration number Clinicaltrials.gov NCT01510210.

Influence of atrial fibrillation on microRNA expression profiles in left and right atria from patients with valvular heart disease

2012 ◽  
Vol 44 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Nicola Cooley ◽  
Mark J. Cowley ◽  
Ruby C. Y. Lin ◽  
Silvana Marasco ◽  
Chiew Wong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Mirna Expression ◽  
Valvular Heart Disease ◽  
Left Atrial ◽  
Expression Profiles ◽  
Artery Bypass ◽  
Expression Patterns ◽  
Right Atrial ◽  
Detectable Effect

Chronic atrial fibrillation (AF) is a complication associated with the dilated atria of patients with valvular heart disease and contributes to worsened pathology. We examined microRNA (miRNA) expression profiles in right and left atrial appendage tissue from valvular heart disease (VHD) patients. Right atrial (RA) appendage from patients undergoing coronary artery bypass grafting and left atrial (LA) appendage from healthy hearts, not used for transplant, were used as controls. There was no detectable effect of chronic AF on miRNA expression in LA tissue, but miRNA expression in RA was strongly influenced by AF, with 47 miRNAs (15 higher, 32 lower) showing differential expression between the AF and control sinus rhythm groups. VHD induced different changes in miRNA expression in LA compared with RA. Fifty-three (12 higher, 41 lower) miRNAs were altered by VHD in LA, compared with 5 (4 higher, 1 lower) in RA tissue. miRNA profiles also differed between VHD-LA and VHD-RA (13 higher, 26 lower). We conclude that VHD and AF influence miRNA expression patterns in LA and RA, but these are affected differently by disease progression and by the development of AF. These findings provide new insights into the progression of VHD.

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.

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