scholarly journals Left atrial volume measurements before and after left atrial ablation for the treatment of atrial fibrillation

2012 ◽  
Vol 14 (S1) ◽  
Author(s):  
Jerry D Walker ◽  
Sathya Vijayakumar ◽  
Eugene Kholmovski ◽  
Nathan S Burgon ◽  
Alan Morris ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Atrial Volume ◽  
Atrial Ablation ◽  
Before And After ◽  
Volume Measurements

scholarly journals Are Three Weeks of Oral Anticoagulation Sufficient for Safe Cardioversion in Atrial Fibrillation?

2021 ◽  
Author(s):  
Stefan Naydenov ◽  
Emil Manov ◽  
Nikolay Runev
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Base Line ◽  
Atrial Volume ◽  
Open Label ◽  
Open Label Study ◽  
Before And After ◽  
And Function

Background: Patients with atrial fibrillation (AF), lasting >48 h, considered for cardioversion, are recommended ≥3 weeks of oral anticoagulation before sinus rhythm restoration because of high risk of development of left atrial thrombosis (LAT) and stroke. However, the optimal duration of anticoagulation in the presence of overt LAT is unknown. Methods: An open-label study, aiming to investigate the prevalence of spontaneous echo con-trast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment. We included 51 consecutive patients (50.9% males), mean age 69.3±7.4 years with paroxys-mal/unknown duration of AF, considered for cardioversion, who agreed to have transesophage-al echocardiography at enrollment and 3 weeks later. Results: At baseline SEC was present in 26 (50.9%) and LAT in 10 (19.6%) of 51 patients. After 3 weeks on DOAC, SEC persisted in 12 (25.0%) and LAT in 7 (14.5%) of 48 patients, p<0.05 vs base-line. Factors, associated most strongly with persistence of SEC/LAT were left atrial appendage (LAA) emptying velocity <20 cm/s (OR=2.82), LAA lobes >2 (OR=1.84) and indexed left atrial volume ≥34 ml/m2 (OR=1.37). Conclusions: The recommended minimal period of 3 weeks of oral anticoagulation lead to SEC/LAT resolution in 47% of our patients. To our opinion, LA/LAA morphology and function should be taken into account when determining the duration of DOAC treatment before planned cardioversion.

scholarly journals Are Three Weeks of Oral Anticoagulation Sufficient for Safe Cardioversion in Atrial Fibrillation?

2021 ◽  
Author(s):  
Stefan Naydenov ◽  
Emil Manov ◽  
Nikolay Runev
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Base Line ◽  
Atrial Volume ◽  
Open Label ◽  
Open Label Study ◽  
Before And After ◽  
And Function

Background: Patients with atrial fibrillation (AF), lasting >48 h, considered for cardioversion, are recommended ≥3 weeks of oral anticoagulation before sinus rhythm restoration because of high risk of development of left atrial thrombosis (LAT) and stroke. However, the optimal duration of anticoagulation in the presence of overt LAT is unknown. Methods: An open-label study, aiming to investigate the prevalence of spontaneous echo con-trast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment. We included 51 consecutive patients (50.9% males), mean age 69.3±7.4 years with paroxys-mal/unknown duration of AF, considered for cardioversion, who agreed to have transesophage-al echocardiography at enrollment and 3 weeks later. Results: At baseline SEC was present in 26 (50.9%) and LAT in 10 (19.6%) of 51 patients. After 3 weeks on DOAC, SEC persisted in 12 (25.0%) and LAT in 7 (14.5%) of 48 patients, p<0.05 vs base-line. Factors, associated most strongly with persistence of SEC/LAT were left atrial appendage (LAA) emptying velocity <20 cm/s (OR=2.82), LAA lobes >2 (OR=1.84) and indexed left atrial volume ≥34 ml/m2 (OR=1.37). Conclusions: The recommended minimal period of 3 weeks of oral anticoagulation lead to SEC/LAT resolution in 47% of our patients. To our opinion, LA/LAA morphology and function should be taken into account when determining the duration of DOAC treatment before planned cardioversion.

scholarly journals Are Three Weeks of Oral Anticoagulation Sufficient for Safe Cardioversion in Atrial Fibrillation?

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 554
Author(s):  
Stefan Naydenov ◽  
Nikolay Runev ◽  
Emil Manov
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Open Label ◽  
Before And After ◽  
Individualized Approach ◽  
Baseline Factors ◽  
And Function

Background and Objectives: Patients with atrial fibrillation (AF), lasting >48 h, considered for cardioversion, are recommended ≥3 weeks of oral anticoagulation before sinus rhythm restoration because of high risk of development of left atrial thrombosis (LAT) and stroke. However, the optimal duration of anticoagulation in the presence of overt LAT is unknown. Materials and Methods: An open-label study aimed to investigate the prevalence of spontaneous echo contrast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment. We included 51 consecutive patients (50.9% males), mean age 69.3 ± 7.4 years with paroxysmal/unknown duration of AF, considered for cardioversion, who agreed to have transesophageal echocardiography at enrollment and 3 weeks later. Results: At baseline SEC was present in 26 (50.9%) and LAT in 10 (19.6%) of 51 patients. After 3 weeks on DOAC, SEC persisted in 12 (25.0%) and LAT in 7 (14.5%) of 48 patients, p < 0.05 vs. baseline. Factors, associated most strongly with persistence of SEC/LAT, were left atrial appendage (LAA) emptying velocity <20 cm/s (OR = 2.82), LAA lobes >2 (OR = 1.84), and indexed left atrial volume ≥34 mL/m2 (OR = 1.37). Conclusions: In our study the incidence of SEC/LAT, particularly in AF with unknown duration, was not as low as we expected. The prevalence of SEC/LAT seemed to be dependent on factors not routinely evaluated in AF patients planned for cardioversion (indexed LA volume, LAA morphology and number of lobules, LAA emptying velocity, etc.). Our data suggested an individualized approach for DOAC duration in AF patients before an attempt for restoration of sinus rhythm is made, taking into consideration the LAA morphology and function.

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.

Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jorge Pagola ◽  
Jesus Juega ◽  
Jaume Francisco ◽  
Maite Rodriguez ◽  
Juan Antonio Cabezas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cumulative Incidence ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Holter Monitoring ◽  
Cardiac Monitoring ◽  
Atrial Volume ◽  
Monitoring Time ◽  
Number Of Patients

Introduction: External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke. Methods: A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed. Results: A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p<0.001). Conclusions: In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.

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