scholarly journals A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Author(s):  
Jun Ding ◽  
Jing Xu ◽  
Wei Ma ◽  
Bingwei Chen ◽  
Peigen Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Dwell Time ◽  
Pulmonary Veins ◽  
Group Versus ◽  
Conventional Group ◽  
Optimal Dosage ◽  
Total Procedure Time ◽  
The Mean

Abstract Background : The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods: A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 seconds each)(the Cryo-AF Conventional group n=84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of -40°C within 60 seconds (the Cryo-AF Dosing group n=80). Results: We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7±0.8, with no difference between groups (Cryo-AF Conventional , 8.7±0.8 versus Cryo-AF Dosing ,8.6±0.8; P =0.359). The Cryo-AF Dosing group required significantly less total cryotherapy application time (990.60±137.77versus 1501.58±89.60 seconds; P <0.001) and left atrial dwell time (69.91±6.91 versus 86.48±7.03 minutes; P <0.001) than the Cryo-AF Conventional group. Additionally, the Cryo-AF Dosing group required significantly less total procedure time (95.03±6.50 versus 112.43±7.11 minutes; P <0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 minutes. The reconnection rates between the Cryo-AF Conventional and Cryo-AF Dosing groups were similar in that 2.98% and 0.94% of the initially isolated veins were reconnected, respectively, ( P =0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AF Dosing group versus 78.57% in the Cryo-AF Conventional group ( P =0.978). Conclusion: A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

scholarly journals A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Author(s):  
Jun Ding ◽  
Jing Xu ◽  
Wei Ma ◽  
Bingwei Chen ◽  
Peigen Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Dwell Time ◽  
Pulmonary Veins ◽  
Group Versus ◽  
Conventional Group ◽  
Optimal Dosage ◽  
Total Procedure Time ◽  
The Mean

Abstract Background : The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods: A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 seconds each)(the Cryo-AF Conventional group n=84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of -40°C within 60 seconds (the Cryo-AF Dosing group n=80). Results: We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7±0.8, with no difference between groups (Cryo-AF Conventional , 8.7±0.8 versus Cryo-AF Dosing ,8.6±0.8; P =0.359). The Cryo-AF Dosing group required significantly less total cryotherapy application time (990.60±137.77versus 1501.58±89.60 seconds; P <0.001) and left atrial dwell time (69.91±6.91 versus 86.48±7.03 minutes; P <0.001) than the Cryo-AF Conventional group. Additionally, the Cryo-AF Dosing group required significantly less total procedure time (95.03±6.50 versus 112.43±7.11 minutes; P <0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 minutes. The reconnection rates between the Cryo-AF Conventional and Cryo-AF Dosing groups were similar in that 2.98% and 0.94% of the initially isolated veins were reconnected, respectively, ( P =0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AF Dosing group versus 78.57% in the Cryo-AF Conventional group ( P =0.978). Conclusion: A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

scholarly journals A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Author(s):  
Jun Ding ◽  
Jing Xu ◽  
Wei Ma ◽  
Bingwei Chen ◽  
Peigen Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Dwell Time ◽  
Pulmonary Veins ◽  
Group Versus ◽  
Conventional Group ◽  
Optimal Dosage ◽  
Total Procedure Time ◽  
The Mean

Abstract Background : The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods: A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 seconds each)(the Cryo-AF Conventional group n=84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of -40°C within 60 seconds (the Cryo-AF Dosing group n=80). Results: We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7±0.8, with no difference between groups (Cryo-AF Conventional , 8.7±0.8 versus Cryo-AF Dosing ,8.6±0.8; P =0.359). The Cryo-AF Dosing group required significantly less total cryotherapy application time (990.60±137.77versus 1501.58±89.60 seconds; P <0.001) and left atrial dwell time (69.91±6.91 versus 86.48±7.03 minutes; P <0.001) than the Cryo-AF Conventional group. Additionally, the Cryo-AF Dosing group required significantly less total procedure time (95.03±6.50 versus 112.43±7.11 minutes; P <0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 minutes. The reconnection rates between the Cryo-AF Conventional and Cryo-AF Dosing groups were similar in that 2.98% and 0.94% of the initially isolated veins were reconnected, respectively, ( P =0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AF Dosing group versus 78.57% in the Cryo-AF Conventional group ( P =0.978). Conclusion: A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

scholarly journals A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Author(s):  
Jun Ding ◽  
Jing Xu ◽  
Wei Ma ◽  
Bingwei Chen ◽  
Peigen Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Dwell Time ◽  
Pulmonary Veins ◽  
Group Versus ◽  
Conventional Group ◽  
Optimal Dosage ◽  
Total Procedure Time ◽  
The Mean

Abstract Background : The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods: A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 seconds each)(the Cryo-AF Conventional group n=84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of -40°C within 60 seconds (the Cryo-AF Dosing group n=80). Results: We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7±0.8, with no difference between groups (Cryo-AF Conventional , 8.7±0.8 versus Cryo-AF Dosing ,8.6±0.8; P =0.359). The Cryo-AF Dosing group required significantly less total cryotherapy application time (990.60±137.77versus 1501.58±89.60 seconds; P <0.001) and left atrial dwell time (69.91±6.91 versus 86.48±7.03 minutes; P <0.001) than the Cryo-AF Conventional group. Additionally, the Cryo-AF Dosing group required significantly less total procedure time (95.03±6.50 versus 112.43±7.11 minutes; P <0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 minutes. The reconnection rates between the Cryo-AF Conventional and Cryo-AF Dosing groups were similar in that 2.98% and 0.94% of the initially isolated veins were reconnected, respectively, ( P =0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AF Dosing group versus 78.57% in the Cryo-AF Conventional group ( P =0.978). Conclusion: A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

scholarly journals A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jun Ding ◽  
Jing Xu ◽  
Wei Ma ◽  
Bingwei Chen ◽  
Peigen Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Dwell Time ◽  
Pulmonary Veins ◽  
Group Versus ◽  
Optimal Dosage ◽  
Total Procedure Time ◽  
The Mean ◽  
Total Procedure

Abstract Background The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 s each) (the Cryo-AFConventional group n = 84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of − 40 °C within 60 s (the Cryo-AFDosing group n = 80) Results We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7 ± 0.8, with no difference between groups (Cryo-AFConventional, 8.7 ± 0.8 versus Cryo-AFDosing,8.6 ± 0.8; P = 0.359). The Cryo-AFDosing group required significantly less total cryotherapy application time (990.60 ± 137.77versus 1501.58 ± 89.60 s; P < 0.001) and left atrial dwell time (69.91 ± 6.91 versus 86.48 ± 7.03 min; P < 0.001) than the Cryo-AFConventional group. Additionally, the Cryo-AFDosing group required significantly less total procedure time (95.03 ± 6.50 versus 112.43 ± 7.11 min; P < 0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 min. The reconnection rates between the Cryo-AFConventional and Cryo-AFDosing groups were similar in that 2.98 and 0.94% of the initially isolated veins were reconnected, respectively, (P = 0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AFDosing group versus 78.57% in the Cryo-AFConventional group (P = 0.978). Conclusion A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

Abstract 4649: A Radiofrequency HOT Balloon Catheter for Isolating the Posterior Left Atrium Including All the Pulmonary Veins in the Treatment of Atrial Fibrillation: Feasibility and Safety of a New Approach

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroshi Sohara ◽  
Shutaro Satake ◽  
Hiroshi Takeda ◽  
Hideki Ueno ◽  
Toshimichi Oda
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Phrenic Nerve ◽  
Pulmonary Veins ◽  
Balloon Catheter ◽  
Holter Monitoring ◽  
Phrenic Nerve Palsy ◽  
Total Procedure Time ◽  
Successful Isolation

Atrial fibrillation (AF) is originated from mostly from pulmonary vein (PV) foci or non-PV foci in the posterior left atrium (PLA). The present study was designed to evaluate the usefulness of a radiofrequency HOT balloon catheter (RBC) for isolation of the PLA including all PVs en masse in the patients with AF. In a total of 96 patients (75 men and 21 women; mean age 64±8 years old) with drug-resistant paroxysmal (n=63) and persistent AF(n=33), PLA including all PVs were ablated and isolated using RBC. Dragging the balloon, contiguous lesions at the roof between the superior PVs were first created, then each antrum of all PVs were ablated, and finally, contiguous lesions at the PLA between the both inferior PVs were made, while we performed monitoring esophagus temperature and phrenic nerve pacing. Electro-anatomical bipolar voltage amplitude mapping (CARTO) of the LA-PVs was performed to determine the extent of this electrical isolation after all procedure. Successful isolation of the PLA including all PVs was achieved in all of 96 cases with elimination of all the PLA and PV potentials. The mean total procedure time 133 ± 31 minutes including 32±9 minutes fluoroscopy time. Recurrences of AF were diagnosed by Holter monitoring, mobile electrocardiogram. After first session, eighty- seven (59 paroxysmal, 28 persistent) of 96 patients were free from AF without anti-arrhythmic drugs and the remaining patients could maintain sinus rhythm with anti-arrhythmic drugs except two cases with LA flutter during 11.0±4.1 months follow-up. No major complications such as cerebral embolism, PV stenosis, or phrenic nerve palsy, and LA-esophageal fistula were observed. Complete isolation of the PLA including all PVs using a RBC, is useful for the treatment of both paroxysmal and persistent AF without severe complication.

scholarly journals Results of the Thoracoscopic Radiofrequency Epicardial Ablation with a Bipolar Electrode During Longstanding Persistent form of Atrial Fibrillation

2020 ◽  
Vol 159 ◽  
pp. 08007
Author(s):  
Rustem Tuleutaev ◽  
Alibek Oshakbayev ◽  
Kuat Abzaliyev ◽  
Baurzhan Rakishev ◽  
Symbat Abzaliyeva
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Bipolar Electrode ◽  
Epicardial Ablation ◽  
Input And Output ◽  
Mean Size ◽  
The Mean ◽  
Β Blockers

Thoracoscopic ablation using the ‘box lesion’ technique was performed using a bipolar radio frequency clamp. A total of 48 patients, including 38 men and 10 women, mean age 58 years (range 33 74). The mean duration of AF was 4 yrs (range 1.5 months 21), the mean size of the atrium 4.15 ± 0.9 cm (2.9-8.8 cm), mean LVEF was 57.7% (39 -73%). Mitral regurgitation of 1-2 degrees was present in 14 patients, EDV LV 147.7 ml (81-224). Primary catheter ablation was performed in 22 patients, where 5 of them (22,7%) were performed repeatedly. Resection of the left atrial appendage (LAA) during the operation was performed in 44 patients (91%). Input and output block was achieved in all patients. In the postoperative period, all patients were administered supporting antiarrhythmic therapy with amiodarone and β-blockers, anticoagulant therapy with warfarin or PLA for 6-12 months. The effectiveness of treatment was monitored by a cardiomonitor Reveal XT in the period 1, 3, 6, 12, 24 months after surgery, the mean follow-up length was 498 ± 19 days. Sinus rhythm was restored during surgery in all patients and remained until discharge.

P563Hemoptysis after cryoablation for atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Kumar ◽  
I Aksoy
Keyword(s):  
Atrial Fibrillation ◽  
Meta Analysis ◽  
Pulmonary Veins ◽  
Systemic Review ◽  
Cochrane Library ◽  
Cryoballoon Ablation ◽  
The Mean ◽  
Lower Temperature ◽  
Severe Type

Abstract Aim Cryoballoon is a widely used tool for ablation for atrial fibrillation (AF). There are several complications after cryoablation. This paper assesses the incidence rate and severity of hemoptysis after cryo ablation for AF. Methods For current systemic review and meta-analysis, literature has been reviewed from 2008 to 2019 focusing on the incidence of hemoptysis after cryoballoon ablation for atrial fibrillation catheter ablation in PubMed, Cochrane library and EMBASE databases. Results This meta-analysis included 3534 patients from 20 studies; of mean age 54.0 ± 10.9 years. All patients had cryoballoon ablation for paroxysmal or persistent AF refractory to treatment and follow up duration for 8.2 ± 5.9 months with mean procedure duration of 153.4± 65.4 minutes. The mean cryoablation duration was 869.4 ± 148 sec with mean temperature of -59.7 ± 5.1 °C and a total of 109 patients (3.08%) had hemoptysis which was mild in the majority of cases (76.1%), mild to moderate in 20.2% and severe in only 3.7%.  Hemoptysis onset was at 29.0 ± 56.5 day with median of 7 days, range (2 hours to 210 days). In 11 studies hemoptysis occurred early in 51 patients (95% CI for I2 was 0.0% to 0.0, P =0.95, I2 was 0.0%), but in 9 studies, hemoptysis occurred late in 58 patients (95% CI for I2 was 0.0% to 0.0, P =0.96, I2 was 0.0%). Conclusion Mild hemoptysis is experienced by significant number of cryoballoon AF ablation patients and severe type in 3.5 % attributed to significantly lower temperature in inferior pulmonary veins and is more often associated with bigger cryoballoon. Abstract Figure. Overview of the manuscripts selection

scholarly journals Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
O H M A Riad ◽  
T Wong ◽  
A N Ali ◽  
M T Ibrahim ◽  
M A Abdelhamid ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
The Mean

Abstract Background Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities. Aim and Objectives to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation. Patients and Methods Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device. Results A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p &lt; 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606). Conclusion Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.

scholarly journals Left atrial size derived by non-contrast cardiac computed tomography and risk of incident atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.H Fredgart ◽  
J.S Lindholt ◽  
A Brandes ◽  
F.H Steffensen ◽  
L Frost ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cardiac Computed Tomography ◽  
Pulmonary Veins ◽  
Population Based ◽  
Individual Risk ◽  
Funding Source ◽  
Screening Trial

Abstract Introduction Left atrial (LA) size is an independent predictor of cardiovascular outcome. While performing non-contrast computed tomography (NCCT), LA size is readily available, and a single cross-section area provides a accurate estimate of LA enlargement. Purpose The purpose of this study was to examine if enlarged LA measured by a NCCT scan was an independent risk factor of subsequent atrial fibrillation or flutter (AF). Methods The Cardiovascular Screening Trial; a population-based multicenter randomized screening trial, consisting primarily of men aged 60–74 years were randomly allocated (1:2) for screening. NCCT was performed and LA area was manually traced in a single axial slice excluding the pulmonary veins at mitral valve level. LA size was indexed to body surface area. Indexed LA area was divided into five categories (defined by standard deviations). Hospital admission due to AF were identified using data from the National Patient Registry using ICD-10 codes (DI48-DI489). Results Between 2014 and 2019, 14,986 participants were enrolled, of these 13,410 without known AF were eligible for follow-up. During 2.3±1.0 years of follow-up 301 developed incident AF, corresponding to an incidence rate of 10.0 per 1,000 person-years. Figure 1 shows the Kaplan-Meier of incident AF stratified by categories of LA (p&lt;0.0001). A very large LA was associated with a four-fold higher risk of incident AF in the fully adjusted analysis (HR (95% CI): 4.0 (2.6–5.8), p&lt;0.0001), and a two-fold higher risk by a large LA (HR (95% CI): 2.0 (1.5–2.6), p&lt;0.0001) (Table 1). Conclusion An enlarged LA area measured by NCCT was associated with a two to four-fold higher risk of incident AF. The prognostic use of LA area provides an individual risk assessment during NCCT for other purposes. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by the University of Southern Denmark and the Region of Southern Denmark.

Abstract P025: Left Atrial Dilatation Predicts The Incidence Of Persistent Atrial Fibrillation In Japanese General Population; The Suita Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Aya Higashiyama ◽  
Makoto Watanabe ◽  
Yoshihiro Kokubo ◽  
Tomonori Okamura ◽  
Akira Okayama ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Cvd Risk ◽  
Japanese General Population ◽  
The Mean ◽  
The Relationship

Objective: Atrial fibrillation (AF) is an important risk factor for cardiovascular disease (CVD). Left atrial (LA) dilatation detected by ultrasonic cardiography (UCG) has been reported to be associated with the incidence of AF in Western countries. However, the relationship between LA dilatation and the AF incidence has not been well investigated in Asian countries, with lower incidence of AF and obesity and with higher incidence of hypertension and stroke. To investigate the relationship between LA dilatation and the AF incidence in Japanese general population, we estimated the multivariate-adjusted hazard ratios (HR) of LA dilatation assessed by UCG for the incidence of AF. Methods: Participants were 1,585 individuals without AF (665 men, 920 women) who are the participants of a prospective cohort study for CVD incidence in urban Japanese general population (the Suita study). The mean±SD age of the participants were 67.8±7.0 years. Transthoracic UCG was performed from July in 2007 to June in 2013, and LA dimension was determined in accordance with American Society of Echocardiography recommendations by M-mode echocardiograms. After the UCG, the electrocardiograms (ECG) were repeatedly performed until March in 2016. The physicians coded the ECG using Minnesota Code (MC), and AF code is defined as 8-3-1. The HRs of LA dilatation for the incidence of AF with 95% confidence interval (CI) were estimated by Cox proportional hazard model with the adjustment for the followings at the UCG test; age, sex, systolic blood pressure, body mass index, the presence of heavy drinking (more than 2 drinks/day), non-HDL cholesterol, and the presence of the moderate or severe mitral or aortic valve abnormality detected by UCG. Results: The mean follow-up period from UCG to the last ECG was 4.6±1.8 years, and 19 AF incidences were detected. The multivariate-adjusted HR of the LA dilatation (>40 mm) for the incidence of AF was 8.19 (95% CI: 2.47-27.14). And the multivariate-adjusted HR of 5 mm increment of LA dimension was 2.95 (1.65-5.29), and that of the highest quartile of LA dimension compared to the lowest was 3.37 (0.64-17.78). Among 674 participants with left atrial volume index (LAVI) data (5 AF cases), the multivariate-adjusted HR of LAVI ≥ 32 (ml/m 2 ) for AF incidence was 3.93 (95%CI: 0.34-45.86), and it showed the highest HR among the co-adjusted factors. Conclusion: LA diameter assessed by UCG is a simple and non-invasive clinical data, and could be a useful factor for the prediction of AF incidence among Japanese general population. Although the follow-up period was not enough compared to the previous studies in Western population, the present study might indicate that individuals with LA dilation detected by UCG are the important candidate for careful and continuous check-ups about CVD risk factors, ECG and UCG in Asian population.

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