Hyperemic myocardial blood flow in patients with atrial fibrillation before and after catheter ablation: A dynamic stress CT perfusion study

Objective Catheter ablation of atrial fibrillation (AF) can lead to thromboembolic complications, especially stroke. We measured the periprocedural serum neuron-specific enolase (NSE) level, which is a biomarker of neuronal injury, after ablation of AF. Methods Forty-three patients with paroxysmal AF were prospectively enrolled before radiofrequency ablation. A neurological examination was performed before and after the procedure. The serum NSE level was determined before and at the end of the procedure and at 2, 24, and 48 h after the procedure. Results No patients developed new neurological deficits. However, the median (interquartile range) NSE level increased after ablation from 6.7 (3.87) ng/mL at baseline to 11.48 (5.3) ng/mL at 24 h postoperatively. The NSE level exceed the upper reference limit of normal (17 ng/mL) in 14 patients (33%), and these patients were found to have a larger left atrium. Conclusions Serum NSE increased in most of the patients undergoing ablation for AF, and it exceeded the normal limit in one-third of the patients. Although NSE is a biomarker of neuronal injury, the clinical importance of this increase after AF ablation and its relationship with the left atrial diameter should be evaluated in a longitudinal study.

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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 ◽

10.1161/circ.118.suppl_18.s_829-b ◽

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.

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Stress Myocardial Blood Flow Ratio by Dynamic CT Perfusion Identifies Hemodynamically Significant CAD

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2019.06.016 ◽

2020 ◽

Vol 13 (4) ◽

pp. 966-976 ◽

Cited By ~ 8

Author(s):

Junjie Yang ◽

Guanhua Dou ◽

Bai He ◽

Qinhua Jin ◽

Zhiye Chen ◽

...

Keyword(s):

Blood Flow ◽

Myocardial Blood Flow ◽

Ct Perfusion ◽

Dynamic Ct ◽

Flow Ratio ◽

Stress Myocardial Blood Flow ◽

Blood Flow Ratio

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Advanced Interatrial Block in Patients with Paroxysmal Atrial Fibrillation Before and After Catheter Ablation

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2019.01.075 ◽

2019 ◽

Vol 53 ◽

pp. e21

Author(s):

Elena Blinova ◽

Tamara Sakhnova ◽

Oleg Sapelnikov ◽

Dmitriy Cherkashin ◽

Renat Akchurin

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Before And After ◽

Interatrial Block

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Velocity characteristics of atrial fibrillation sources determined by electrographic flow mapping before and after catheter ablation

International Journal of Cardiology ◽

10.1016/j.ijcard.2019.02.006 ◽

2019 ◽

Vol 286 ◽

pp. 56-60 ◽

Cited By ~ 6

Author(s):

Barbara Bellmann ◽

Marit Zettwitz ◽

Tina Lin ◽

Peter Ruppersberg ◽

Selma Guttmann ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Flow Mapping ◽

Before And After

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Advanced Interatrial Block in Patients with Paroxysmal Atrial Fibrillation Before and After Catheter Ablation

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2018.10.075 ◽

2018 ◽

Vol 51 (6) ◽

pp. 1182-1183

Author(s):

Elena Blinova ◽

Tamara Sakhnova ◽

Oleg Sapelnikov ◽

Dmitriy Cherkashin ◽

Renat Akchurin

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Before And After ◽

Interatrial Block

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Improved brain perfusion after electrical cardioversion of atrial fibrillation

EP Europace ◽

10.1093/europace/euz336 ◽

2019 ◽

Vol 22 (4) ◽

pp. 530-537 ◽

Cited By ~ 3

Author(s):

Marianna Gardarsdottir ◽

Sigurdur Sigurdsson ◽

Thor Aspelund ◽

Valdis Anna Gardarsdottir ◽

Lars Forsberg ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Atrial Fibrillation ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Magnetic Resonance ◽

Brain Perfusion ◽

Resonance Imaging ◽

Flow Measurements ◽

Before And After ◽

Blood Flow Measurements

Abstract Aims Atrial fibrillation (AF) has been associated with reduced brain volume, cognitive impairment, and reduced cerebral blood flow. The causes of reduced cerebral blood flow in AF are unknown, but no reduction was seen in individuals without the arrhythmia in a previous study. The aim of this study was to test the hypothesis that brain perfusion, measured with magnetic resonance imaging (MRI), improves after cardioversion of AF to sinus rhythm (SR). Methods and results All patients undergoing elective cardioversion at our institution were invited to participate. A total of 44 individuals were included. Magnetic resonance imaging studies were done before and after cardioversion with both brain perfusion and cerebral blood flow measurements. However, 17 did not complete the second MRI as they had a recurrence of AF during the observation period (recurrent AF group), leaving 17 in the SR group and 10 in the AF group to complete both measurements. Brain perfusion increased after cardioversion to SR by 4.9 mL/100 g/min in the whole brain (P < 0.001) and by 5.6 mL/100 g/min in grey matter (P < 0.001). Cerebral blood flow increased by 58.6 mL/min (P < 0.05). Both brain perfusion and cerebral blood flow remained unchanged when cardioversion was unsuccessful. Conclusion In this study of individuals undergoing elective cardioversion for AF, restoration, and maintenance of SR for at least 10 weeks after was associated with an improvement of brain perfusion and cerebral blood flow measured by both arterial spin labelling and phase contrast MRI. In those individuals where cardioversion was unsuccessful, there was no change in perfusion or blood flow.

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