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Virk SA, Ho WWH, Takeuchi F, Morris GM, Kistler PM, Kalman J. Risk of ischemic stroke in sinus node dysfunction with and without atrial fibrillation: evidence for the presence of a left atrial myopathy in patients with isolated sinus node dysfunction - an analysis of the UK Biobank. Heart Rhythm 2025:S1547-5271(25)02403-8. [PMID: 40315941 DOI: 10.1016/j.hrthm.2025.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 04/14/2025] [Accepted: 04/24/2025] [Indexed: 05/04/2025]
Abstract
BACKGROUND Emerging evidence indicates sinus node dysfunction (SND) may be an important marker of a biatrial myopathy. However, the relative risk of ischemic stroke in isolated SND has not been clearly delineated in comparative prospective studies. OBJECTIVE This study examined the association between SND (with and without concomitant atrial fibrillation [AF]) and ischemic stroke (IS) in the United Kingdom Biobank (UKB). METHODS The UKB is a prospective, population-based cohort of >500,000 individuals aged 40-69 years recruited across the UK between 2006 and 2010, with follow-up extending beyond 10 years. Incident health events were longitudinally tracked through electronic health record linkages with hospital admissions, primary care records and death registration data using ICD-10 coding. Individuals with SND, AF or both were identified. Patients with prosthetic heart valves, rheumatic mitral valve diseases, mitral stenosis and prior IS were excluded. The primary endpoint was time to IS. RESULTS Of the 451,493 participants (median age 57 years, 44.2% male) included in this study: 593 had isolated SND, 955 had combined SND and AF, 37,065 had isolated AF and 412,880 comprised controls with neither SND nor AF. During median follow-up of 13.2 years, yearly IS incidence was 0.37%, 0.60%, 0.59% and 0.10% in these groups, respectively. In multivariable competing-risk regression modelling accounting for death, isolated SND conferred a significantly increased risk of IS compared to controls (sub-distribution hazard ratio [SHR] 2.28; 95% CI, 1.57-3.31; p<0.001). Participants with AF and SND had similar risk of IS, compared to those with isolated AF (SHR 1.07; 95% CI, 0.84-1.37; p=0.58). CONCLUSIONS SND is an independent risk marker for development of IS in individuals without AF. This provides further evidence of SND being an electrical marker of a biatrial myopathy.
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Affiliation(s)
- Sohaib A Virk
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - William W H Ho
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
| | | | - Gwilym M Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Department of Cardiology, John Hunter Hospital, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Peter M Kistler
- University of Melbourne, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
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Sommer P, Castellano S, Ahapov K, Jansen MM, Mehta NK, Kong MH. A single-center trial of electrographic flow mapping and concomitant voltage mapping in sinus rhythm and atrial fibrillation (FLOW EVAL-AF). J Interv Card Electrophysiol 2024:10.1007/s10840-024-01946-0. [PMID: 39604766 DOI: 10.1007/s10840-024-01946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 11/06/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Electrographic flow (EGF) mapping reconstructs atrial electrical wavefront propagation, potentially revealing sources of atrial fibrillation (AF). Electrographic flow consistency (EGFC) measures the concurrence of wavefront patterns and may provide insights into atrial substrate health. This study aimed to compare EGF patterns during atrial fibrillation (AF) with sinus rhythm (SR) and explore the correlation between EGFC and regional bipolar voltage. METHODS In this single-center, prospective study, AF patients underwent mapping of the atria using bipolar voltage and EGF mapping. Mapping was performed during both AF and SR using a 16-electrode grid catheter (bipolar mapping) and a 64-pole basket catheter (EGF mapping). EGFC was computed as the average modulus of individual EGF vectors, reflecting flow pattern consistency. RESULTS Ten patients were enrolled. EGF identified 11 sources with a mean source activity of 32 ± 9% during AF. Eight out of eleven sources in AF converted to passive "sinks" when mapped in SR. EGFC was significantly lower during AF compared to SR (0.74 ± 0.14 vs 1.0 ± 0.11 AUs, P < 0.01), consistent with EGFC quantifying the more chaotic wavefront propagation during arrhythmia. No spatial correlation between areas of high EGFC during AF and SR was observed. EGFC correlated with bipolar voltage across rhythms and atria (r = 0.647, P < 0.0001). CONCLUSION EGF patterns varied by rhythm with AF showing lower EGFC values. EGFC correlated with bipolar voltage across rhythms and atria, suggesting its potential as an atrial myopathy marker akin to high-density voltage mapping and offering insights into atrial substrate health. Trial registration ClinicalTrials.gov Identifier: NCT06260670.
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Affiliation(s)
- Philipp Sommer
- Med. Fakultät OWL, Clinic for Electrophysiology, Herz- and Diabeteszentrum NRW, Ruhr University Bochum, University Bielefeld, Bad Oeynhausen, Germany
| | | | | | | | - Nishaki K Mehta
- Department of Cardiology, Corewell William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Virk SA, Kalman J. Sinus node dysfunction: An underrecognized marker of biatrial myopathy? Heart Rhythm 2024:S1547-5271(24)03517-3. [PMID: 39481775 DOI: 10.1016/j.hrthm.2024.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/23/2024] [Accepted: 10/24/2024] [Indexed: 11/02/2024]
Affiliation(s)
- Sohaib A Virk
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia.
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Sonaglioni A, Nicolosi GL, Bruno A, Lombardo M, Muti P. Echocardiographic Assessment of Left Atrial Mechanics in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion: A Systematic Review. J Clin Med 2024; 13:6296. [PMID: 39518435 PMCID: PMC11546254 DOI: 10.3390/jcm13216296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 10/17/2024] [Accepted: 10/20/2024] [Indexed: 11/16/2024] Open
Abstract
Background: To date, only a few studies have evaluated left atrial (LA) mechanics in patients with atrial fibrillation (AF) scheduled for electrical cardioversion (ECV). The present systematic review has been primarily designed to summarize the main findings of these studies and to examine the overall effect of AF on left atrial reservoir strain (LASr) in patients undergoing ECV. Methods: All the echocardiographic studies evaluating the effect of AF on LA mechanics in patients scheduled for ECV, selected from the PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The full texts of 12 studies with 880 AF patients were analyzed. The pooled ECV success rate was 91.5% (range 65.8-100%). Over a median follow-up of 5.4 months (range 0.3-12 months), 35.2% of the patients (range 5-68.8%) experienced AF recurrence. At baseline, the average LASr was 11.4% (range 6.2-17.7%). A reduced LASr before ECV was strongly correlated with reduced left atrial appendage (LAA) flow velocities and/or thrombosis. The main independent predictors of cardioversion failure were impaired LASr and previous AF history. A severe LASr deterioration was independently correlated with AF recurrence after ECV. The other independent predictors of AR relapses were LA asynchrony, reduced difference between post- and pre-ECV LASr, and reduced right atrial reservoir strain. Conclusions: LASr assessment before ECV may provide useful prognostic information about AF relapses and improve the refinement of the thromboembolic risk of AF patients scheduled for ECV.
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Affiliation(s)
| | | | - Antonino Bruno
- Laboratory of Innate Immunity, IRCCS MultiMedica, 20138 Milan, Italy;
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | | | - Paola Muti
- Department of Biomedical, Surgical and Dental Sciences, Università di Milano, 20122 Milan, Italy;
- Scientific Direction, IRCCS MultiMedica, 20138 Milan, Italy
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Hussain S, Falanga M, Chiaravalloti A, Tomasi C, Corsi C. Patient-specific left atrium contraction quantification associated with atrial fibrillation: A region-based approach. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 249:108138. [PMID: 38522329 DOI: 10.1016/j.cmpb.2024.108138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF) is a widespread cardiac arrhythmia that significantly impacts heart function. AF disrupts atrial mechanical contraction, leading to irregular, uncoordinated, and slow blood flow inside the atria which favors the formation of clots, primarily within the left atrium (LA). A standardized region-based analysis of the LA is missing, and there is not even any consensus about how to define the LA regions. In this study we propose an automatic approach for regionalizing the LA into segments to provide a comprehensive 3D region-based LA contraction assessment. LA global and regional contraction were quantified in control subjects and in AF patients to describe mechanical abnormalities associated with AF. METHODS The proposed automatic approach for LA regionalization was tested in thirteen control subjects and seventeen AF patients. After dividing LA into standard regions, we evaluated the global and regional mechanical function by measuring LA contraction parameters, such as regional volume, global and regional strains, regional wall motion and regional shortening fraction. RESULTS LA regionalization was successful in all study subjects. In the AF group compared with control subjects, results showed: a global impairment of LA contraction which appeared more pronounced along radial and circumferential direction; a regional impairment of radial strain which was more pronounced in septal, inferior, and lateral regions suggesting a greater reduction in mechanical efficiency in these regions in comparison to the posterior and anterior ones. CONCLUSION An automatic approach for LA regionalization was proposed. The regionalization method was proved to be robust with several LA anatomical variations and able to characterize contraction changes associated with AF.
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Affiliation(s)
| | | | | | - Corrado Tomasi
- Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
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Martínez Díaz P, Sánchez J, Fitzen N, Ravens U, Dössel O, Loewe A. The right atrium affects in silico arrhythmia vulnerability in both atria. Heart Rhythm 2024; 21:799-805. [PMID: 38301854 DOI: 10.1016/j.hrthm.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Patricia Martínez Díaz
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Jorge Sánchez
- Institute of Information and Communication Technologies (ITACA), Universitat Politècnica de València (UPV), Valencia, Spain
| | - Nikola Fitzen
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Ursula Ravens
- Institute for Experimental Cardiovascular Medicine, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
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Ye Z, van Schie MS, Pool L, Heida A, Knops P, Taverne YJHJ, Brundel BJJM, de Groot NMS. Characterization of unipolar electrogram morphology: a novel tool for quantifying conduction inhomogeneity. Europace 2023; 25:euad324. [PMID: 37931071 PMCID: PMC10657215 DOI: 10.1093/europace/euad324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023] Open
Abstract
AIMS Areas of conduction inhomogeneity (CI) during sinus rhythm may facilitate the initiation and perpetuation of atrial fibrillation (AF). Currently, no tool is available to quantify the severity of CI. Our aim is to develop and validate a novel tool using unipolar electrograms (EGMs) only to quantify the severity of CI in the atria. METHODS AND RESULTS Epicardial mapping of the right atrium (RA) and left atrium, including Bachmann's bundle, was performed in 235 patients undergoing coronary artery bypass grafting surgery. Conduction inhomogeneity was defined as the amount of conduction block. Electrograms were classified as single, short, long double (LDP), and fractionated potentials (FPs), and the fractionation duration of non-single potentials was measured. The proportion of low-voltage areas (LVAs, <1 mV) was calculated. Increased CI was associated with decreased potential voltages and increased LVAs, LDPs, and FPs. The Electrical Fingerprint Score consisting of RA EGM features, including LVAs and LDPs, was most accurate in predicting CI severity. The RA Electrical Fingerprint Score demonstrated the highest correlation with the amount of CI in both atria (r = 0.70, P < 0.001). CONCLUSION The Electrical Fingerprint Score is a novel tool to quantify the severity of CI using only unipolar EGM characteristics recorded. This tool can be used to stage the degree of conduction abnormalities without constructing spatial activation patterns, potentially enabling early identification of patients at high risk of post-operative AF or selection of the appropriate ablation approach in addition to pulmonary vein isolation at the electrophysiology laboratory.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Lisa Pool
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
- Department of Microelectronics, Delft University of Technology, Mekelweg 5, 2628CD Delft, The Netherlands
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Pozios I, Vouliotis AI, Dilaveris P, Tsioufis C. Electro-Mechanical Alterations in Atrial Fibrillation: Structural, Electrical, and Functional Correlates. J Cardiovasc Dev Dis 2023; 10:jcdd10040149. [PMID: 37103028 PMCID: PMC10141162 DOI: 10.3390/jcdd10040149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Atrial fibrillation is the most common arrhythmia encountered in clinical practice affecting both patients’ survival and well-being. Apart from aging, many cardiovascular risk factors may cause structural remodeling of the atrial myocardium leading to atrial fibrillation development. Structural remodelling refers to the development of atrial fibrosis, as well as to alterations in atrial size and cellular ultrastructure. The latter includes myolysis, the development of glycogen accumulation, altered Connexin expression, subcellular changes, and sinus rhythm alterations. The structural remodeling of the atrial myocardium is commonly associated with the presence of interatrial block. On the other hand, prolongation of the interatrial conduction time is encountered when atrial pressure is acutely increased. Electrical correlates of conduction disturbances include alterations in P wave parameters, such as partial or advanced interatrial block, alterations in P wave axis, voltage, area, morphology, or abnormal electrophysiological characteristics, such as alterations in bipolar or unipolar voltage mapping, electrogram fractionation, endo-epicardial asynchrony of the atrial wall, or slower cardiac conduction velocity. Functional correlates of conduction disturbances may incorporate alterations in left atrial diameter, volume, or strain. Echocardiography or cardiac magnetic resonance imaging (MRI) is commonly used to assess these parameters. Finally, the echocardiography-derived total atrial conduction time (PA-TDI duration) may reflect both atrial electrical and structural alterations.
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Gunturiz-Beltrán C, Borràs R, Alarcón F, Garre P, Figueras I Ventura RM, Benito EM, Caixal G, Althoff TF, Tolosana JM, Arbelo E, Roca-Luque I, Prat-González S, Perea RJ, Brugada J, Sitges M, Guasch E, Mont L. Quantification of right atrial fibrosis by cardiac magnetic resonance: verification of the method to standardize thresholds. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:173-182. [PMID: 35809892 DOI: 10.1016/j.rec.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) allows noninvasive detection of left atrial fibrosis in patients with atrial fibrillation (AF). However, whether the same methodology can be used in the right atrium (RA) remains unknown. Our aim was to define a standardized threshold to characterize RA fibrosis in LGE-CMR. METHODS A 3 Tesla LGE-CMR was performed in 53 individuals; the RA was segmented, and the image intensity ratio (IIR) calculated for the RA wall using 1 557 767 IIR pixels (40 994±10 693 per patient). The upper limit of normality of the IIR (mean IIR+2 standard deviations) was estimated in healthy volunteers (n=9), and patients who had undergone previous typical atrial flutter ablation (n=9) were used to establish the dense scar threshold. Paroxysmal and persistent AF patients (n=10 each) were used for validation. IIR values were correlated with a high-density bipolar voltage map in 15 patients undergoing AF ablation. RESULTS The upper normality limit (total fibrosis threshold) in healthy volunteers was set at an IIR = 1.21. In the postablation group, 60% of the maximum IIR pixel (dense fibrosis threshold) was calculated as IIR = 1.29. Endocardial bipolar voltage showed a weak but significant correlation with IIR. The overall accuracy between the electroanatomical map and LGE-CMR to characterize fibrosis was 56%. CONCLUSIONS An IIR > 1.21 was determined to be the threshold for the detection of right atrial fibrosis, while an IIR > 1.29 differentiates interstitial fibrosis from dense scar. Despite differences between the left and right atria, fibrosis could be assessed with LGE-CMR using similar thresholds in both chambers.
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Affiliation(s)
- Clara Gunturiz-Beltrán
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Roger Borràs
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Francisco Alarcón
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paz Garre
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Eva M Benito
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gala Caixal
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Till F Althoff
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Cardiology and Angiology, Charité-University Medicine Berlin, Charité Campus Mitte, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - José María Tolosana
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Arbelo
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ivo Roca-Luque
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Susanna Prat-González
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rosario Jesús Perea
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Brugada
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Sitges
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduard Guasch
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Sun ZY, Li Q, Li J, Zhang MW, Zhu L, Geng J. Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100274. [PMID: 38511096 PMCID: PMC10945901 DOI: 10.1016/j.ahjo.2023.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 03/22/2024]
Abstract
Right atrial (RA) structural and functional evaluations have recently emerged as powerful biomarkers for adverse events in various cardiovascular conditions. Quantitative analysis of the right atrium, usually performed with volume changes or speckle-tracking echocardiography (STE), has markedly changed our understanding of RA function and remodeling. Knowledge of reference echocardiographic values and measurement methods of RA volumes and myocardial function is a prerequisite to introduce RA quantitation in the clinical routine. This review describes the methodology, benefits and pitfalls of measuring RA size and function by echocardiography based on the current understanding of right atrial anatomy and physiological function and provides the current knowledge of right atrial function in related cardiac diseases.
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Affiliation(s)
- Zhen-Yun Sun
- Department of Diagnostic Ultrasound, Shandong First Medical University & Shandong Academy of Medical Sciences, China
| | - Qiao Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jun Li
- Department of Diagnostic Ultrasound, Shandong First Medical University & Shandong Academy of Medical Sciences, China
| | - Ming-Wei Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Ling Zhu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jing Geng
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
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Gunturiz-Beltrán C, Borràs R, Alarcón F, Garre P, Figueras i Ventura RM, Benito EM, Caixal G, Althoff TF, Tolosana JM, Arbelo E, Roca-Luque I, Prat-González S, Perea RJ, Brugada J, Sitges M, Guasch E, Mont L. Cuantificación de la fibrosis auricular derecha mediante resonancia magnética cardiaca: verificación del método para la estandarización de umbrales. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
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Yu ZX, Yang W, Yin WS, Peng KX, Pan YL, Chen WW, Du BB, He YQ, Yang P. Clinical utility of left atrial strain in predicting atrial fibrillation recurrence after catheter ablation: An up-to-date review. World J Clin Cases 2022; 10:8063-8075. [PMID: 36159552 PMCID: PMC9403688 DOI: 10.12998/wjcc.v10.i23.8063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/03/2022] [Accepted: 07/17/2022] [Indexed: 02/06/2023] Open
Abstract
Rhythm control is the core part of the integrated management of atrial fibrillation (AF), especially in the early stages. Despite advances in catheter ablation (CA), the recurrence rate of AF after CA remains high. As a result, stratification and early management of AF recurrence after CA are critical. Currently, predictors of recurrence of AF after CA are mostly based on dysfunction caused by structural remodeling, apart from traditional risk factors. Atrial strain is a recently developed important parameter for detecting the deformability of atrial myocardium during the cardiac cycle prior to atrial remodeling. Although there is only preliminary evidence, atrial strain is still a promising parameter in predicting the recurrence of AF after CA at an early stage. This review focuses on the evaluation of atrial strain, the current applications of atrial strain in assessing atrial function, and predicting the recurrence of AF after CA. We summarize the contents related as follows: (1) CA for rhythm control in AF; (2) Evaluation methods of atrial strain; (3) Atrial strain in the remodeling and reverse remodeling of AF; and (4) Clinical applications of atrial strain in predicting the recurrence of AF after CA. Although there is accumulating evidence on the role of decreased atrial strain in the early prediction of AF recurrence, atrial strain is limited in clinical practice for lacking exact cut-off values and difficulty in distinguishing specific function phases of the atrium. More research is needed in the future to add strength to the early prediction value of atrial strain in AF recurrences.
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Affiliation(s)
- Zhi-Xi Yu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Wen Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Wei-Si Yin
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Ke-Xin Peng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Yi-Lin Pan
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Wei-Wei Chen
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Bei-Bei Du
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Yu-Quan He
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
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13
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van Schie MS, de Groot NMS. Clinical Relevance of Sinus Rhythm Mapping to Quantify Electropathology Related to Atrial Fibrillation. Arrhythm Electrophysiol Rev 2022; 11:e11. [PMID: 35846426 PMCID: PMC9277615 DOI: 10.15420/aer.2022.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022] Open
Abstract
Progression of AF is accompanied by structural and electrical remodelling, resulting in complex electrical conduction disorders. This is defined as electropathology and it increases with the progression of AF. The severity of electropathology, thus, defines the stage of AF and is a major determinant of effectiveness of AF therapy. As specific features of AF-related electropathology are still unknown, it is essential to first quantify the electrophysiological properties of atrial tissue and then to examine the inter- and intra-individual variation during normal sinus rhythm. Comparison of these parameters between patients with and without a history of AF unravels quantified electrophysiological features that are specific to AF patients. This can help to identify patients at risk for early onset or progression of AF. This review summarises current knowledge on quantified features of atrial electrophysiological properties during sinus rhythm and discusses its relevance in identifying AF-related electropathology.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja MS de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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14
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Nalliah CJ, Wong GR, Lee G, Voskoboinik A, Kee K, Goldin J, Watts T, Linz D, Parameswaran R, Sugumar H, Prabhu S, McLellan A, Ling LH, Joseph SA, Morton JB, Kistler P, Sanders P, Kalman JM. Impact of CPAP on the Atrial Fibrillation Substrate in Obstructive Sleep Apnea: The SLEEP-AF Study. JACC Clin Electrophysiol 2022; 8:869-877. [PMID: 35863812 DOI: 10.1016/j.jacep.2022.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Observational studies report that obstructive sleep apnea (OSA) is associated with an increasingly remodeled atrial substrate in atrial fibrillation (AF). However, the impact of OSA management on the electrophysiologic substrate has not been evaluated. OBJECTIVES In this study, the authors sought to determine the impact of OSA management on the atrial substrate in AF. METHODS We recruited 24 consecutive patients referred for AF management with at least moderate OSA (apnea-hypopnea index [AHI] ≥15). Participants were randomized in a 1:1 ratio to commence continuous positive airway pressure (CPAP) or no therapy (n = 12 CPAP; n = 12 no CPAP). All participants underwent invasive electrophysiologic study (high-density right atrial mapping) at baseline and after a minimum of 6 months. Outcome variables were atrial voltage (mV), conduction velocity (m/s), atrial surface area <0.5 mV (%), proportion of complex points (%), and atrial effective refractory periods (ms). Change between groups over time was compared. RESULTS Clinical characteristics and electrophysiologic parameters were similar between groups at baseline. Compliance with CPAP therapy was high (device usage: 79% ± 19%; mean usage/day: 268 ± 91 min) and resulted in significant AHI reduction (mean reduction: 31 ± 23 events/h). There were no differences in blood pressure or body mass index between groups over time. At follow-up, the CPAP group had faster conduction velocity (0.86 ± 0.16 m/s vs 0.69 ± 0.12 m/s; P (time × group) = 0.034), significantly higher voltages (2.30 ± 0.57 mV vs 1.94 ± 0.72 mV; P < 0.05), and lower proportion of complex points (8.87% ± 3.61% vs 11.93% ± 4.94%; P = 0.011) compared with the control group. CPAP therapy also resulted in a trend toward lower proportion of atrial surface area <0.5 mV (1.04% ± 1.41% vs 4.80% ± 5.12%; P = 0.065). CONCLUSIONS CPAP therapy results in reversal of atrial remodeling in AF and provides mechanistic evidence advocating for management of OSA in AF.
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Affiliation(s)
- Chrishan J Nalliah
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia
| | - Geoffrey R Wong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia
| | - Aleksandr Voskoboinik
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Kirk Kee
- Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Jeremy Goldin
- Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia
| | - Hariharan Sugumar
- Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Sandeep Prabhu
- Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Alex McLellan
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia
| | - Liang-Han Ling
- Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Stephen A Joseph
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia
| | - Joseph B Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia
| | - Peter Kistler
- Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Physiology, University of Melbourne, Melbourne, Australia.
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15
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van Schie MS, Starreveld R, Bogers AJJC, de Groot NMS. Sinus rhythm voltage fingerprinting in patients with mitral valve disease using a high-density epicardial mapping approach. Europace 2021; 23:469-478. [PMID: 33432326 PMCID: PMC7947572 DOI: 10.1093/europace/euaa336] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/06/2020] [Indexed: 12/03/2022] Open
Abstract
Aims Unipolar voltage (UV) mapping is increasingly used for guiding ablative therapy of atrial fibrillation (AF) as unipolar electrograms (U-EGMs) are independent of electrode orientation and atrial wavefront direction. This study was aimed at constructing individual, high-resolution sinus rhythm (SR) UV fingerprints to identify low-voltage areas and study the effect of AF episodes in patients with mitral valve disease (MVD). Methods and results Intra-operative epicardial mapping (interelectrode distance 2 mm) of the right and left atrium, Bachmann’s bundle (BB), and pulmonary vein area was performed in 67 patients (27 male, 67 ± 11 years) with or without a history of paroxysmal AF (PAF). In all patients, there were considerable regional variations in voltages. UVs at BB were lower in patients with PAF compared with those without [no AF: 4.94 (3.56–5.98) mV, PAF: 3.30 (2.25–4.57) mV, P = 0.006]. A larger number of low-voltage potentials were recorded at BB in the PAF group [no AF: 2.13 (0.52–7.68) %, PAF: 12.86 (3.18–23.59) %, P = 0.001]. In addition, areas with low-voltage potentials were present in all patients, yet we did not find any predilection sites for low-voltage potentials to occur. Conclusion Even in SR, advanced atrial remodelling in MVD patients shows marked inter-individual and regional variation. Low UVs are even present during SR in patients without a history of AF indicating that low UVs should carefully be used as target sites for ablative therapy.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Roeliene Starreveld
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015GD Rotterdam, The Netherlands
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16
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Denham NC, Pearman CM, Madders GWP, Smith CER, Trafford AW, Dibb KM. Optimising Large Animal Models of Sustained Atrial Fibrillation: Relevance of the Critical Mass Hypothesis. Front Physiol 2021; 12:690897. [PMID: 34211405 PMCID: PMC8239221 DOI: 10.3389/fphys.2021.690897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/24/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Large animal models play an important role in our understanding of the pathophysiology of atrial fibrillation (AF). Our aim was to determine whether prospectively collected baseline variables could predict the development of sustained AF in sheep, thereby reducing the number of animals required in future studies. Our hypothesis was that the relationship between atrial dimensions, refractory periods and conduction velocity (otherwise known as the critical mass hypothesis) could be used for the first time to predict the development of sustained AF. METHODS Healthy adult Welsh mountain sheep underwent a baseline electrophysiology study followed by implantation of a neurostimulator connected via an endocardial pacing lead to the right atrial appendage. The device was programmed to deliver intermittent 50 Hz bursts of 30 s duration over an 8-week period whilst sheep were monitored for AF. RESULTS Eighteen sheep completed the protocol, of which 28% developed sustained AF. Logistic regression analysis showed only fibrillation number (calculated using the critical mass hypothesis as the left atrial diameter divided by the product of atrial conduction velocity and effective refractory period) was associated with an increased likelihood of developing sustained AF (Ln Odds Ratio 26.1 [95% confidence intervals 0.2-52.0] p = 0.048). A receiver-operator characteristic curve showed this could be used to predict which sheep developed sustained AF (C-statistic 0.82 [95% confidence intervals 0.59-1.04] p = 0.04). CONCLUSION The critical mass hypothesis can be used to predict sustained AF in a tachypaced ovine model. These findings can be used to optimise the design of future studies involving large animals.
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Affiliation(s)
- Nathan C. Denham
- Unit of Cardiac Physiology, Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom
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17
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Takagi T, Nakamura K, Asami M, Toyoda Y, Enomoto Y, Moroi M, Noro M, Sugi K, Nakamura M. Impact of right atrial structural remodeling on recurrence after ablation for atrial fibrillation. J Arrhythm 2021; 37:597-606. [PMID: 34141012 PMCID: PMC8207433 DOI: 10.1002/joa3.12541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/11/2021] [Accepted: 04/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) is associated with left atrial (LA) remodeling; however, its association with right atrial (RA) remodeling remains unclear. OBJECTIVE This study aimed to identify whether RA structural remodeling could predict recurrence of AF after PVI. METHODS This study prospectively analyzed 245 patients with AF who had undergone PVI. RA and LA volumes were determined by contrast-enhanced computed tomography. Atrial structural remodeling was defined as an atrial volume of ≥110 mL according to previous reports and receiver operating characteristic curve analysis. RESULTS After excluding 32 patients, 213 patients were analyzed. During a follow-up period of 12 months, 41 patients (19%) demonstrated atrial arrhythmia recurrence after PVI. With the Cox proportional-hazards model, RA structural remodeling was the only predictor of arrhythmia recurrence (hazard ratio, 1.012; 95% confidence interval 1.003-1.021; P = .009). Kaplan-Meier analysis showed that arrhythmia recurrence was more frequent in the RA structural remodeling group compared with the group without RA remodeling (log-rank, P < .001), and the arrhythmia-free survival rates in these groups at 12 months were 68.0% and 91.4%, respectively. Additionally, there was a significant difference in recurrence-free survival after RA structural remodeling in each type of AF (log-rank, P < .001). CONCLUSIONS RA structural remodeling is a useful predictor of clinical outcome after PVI regardless of the type of AF. Our results suggest that patients without RA structural remodeling may be good candidates for successful ablation with PVI.
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Affiliation(s)
- Takahito Takagi
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Keijiro Nakamura
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Masako Asami
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Yasutake Toyoda
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Yoshinari Enomoto
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Masao Moroi
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Mahito Noro
- Division of Cardiovascular MedicineOdawara Cardiovascular HospitalKanagawaJapan
| | - Kaoru Sugi
- Division of Cardiovascular MedicineOdawara Cardiovascular HospitalKanagawaJapan
| | - Masato Nakamura
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
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18
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Ikoma T, Obokata M, Okada K, Harada T, Sorimachi H, Yoshida K, Kato T, Kurosawa K, Kurabayashi M, Murakami M. Impact of Right Atrial Remodeling in Heart Failure With Preserved Ejection Fraction. J Card Fail 2020; 27:577-584. [PMID: 33385523 DOI: 10.1016/j.cardfail.2020.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few studies have investigated right atrial (RA) remodeling in heart failure (HF) with preserved ejection fraction (HFpEF). This study sought to characterize the RA remodeling in HFpEF and to determine its prognostic significance. METHODS AND RESULTS Patients with HFpEF were classified based on the presence of RA enlargement (RA volume index >39 mL/m2 in men and >33 mL/m2 in women). Compared with patients with normal RA size (n = 234), patients with RA dilation (n = 67) showed a higher prevalence of atrial fibrillation (AF), worse right ventricular systolic function, more severe pulmonary hypertension, and a greater prevalence of mild tricuspid regurgitation, as well as impaired RA reservoir function, with increased hepatobiliary enzyme levels. AF was strongly associated with the presence of RA dilation (odds ratio [OR] 10.2, 95% confidence interval [CI] 4.00-26.1 in current AF vs no AF and odds ratio 3.38, 95% CI 1.26-9.07, earlier AF vs no AF). Patients with RA dilation had more than a two-fold increased risk of composite outcomes of all-cause mortality or HF hospitalization (adjusted hazard ratio 2.01, 95% CI 1.09-3.70, P = .02). The presence of RA dilation also displayed an additive prognostic value over left atrial dilation alone. CONCLUSIONS These data demonstrate that HFpEF with RA remodeling is associated with distinct echocardiographic features characterizing advanced right heart dysfunction with an increased risk of adverse outcomes.
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Affiliation(s)
- Takahiro Ikoma
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Kenya Okada
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kuniko Yoshida
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Toshimitsu Kato
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Koji Kurosawa
- Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masami Murakami
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Gunma, Japan
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19
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The Value of Voltage Histogram Analysis Derived Right Atrial Scar Burden in the Prediction of Left Atrial Scar Burden. Cardiol Res Pract 2020; 2020:3981684. [PMID: 32855820 PMCID: PMC7442993 DOI: 10.1155/2020/3981684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Growing evidence suggests that fibrotic changes can be observed in atrial fibrillation (AF) in both atria. Quantification of the scar burden during electroanatomical mapping might have important therapeutic and prognostic consequences. However, as the current invasive treatment of AF is focused on the left atrium (LA), the role of the right atrium (RA) is less well understood. We aimed to characterize the clinical determinates of the RA low-voltage burden and its relation to the LA scaring. Methods We have included 36 patients who underwent catheter ablation for AF in a prospective observational study. In addition to LA mapping and ablation, high-density RA bipolar voltage maps (HD-EAM) were also reconstructed. The extent of the diseased RA tissue (≤0.5 mV) was quantified using the voltage histogram analysis tool (CARTO®3, Biosense Webster). Results The percentage of RA diseased tissue burden was significantly higher in patients with a CHA2DS2-VASc score ≥ 2 (p = 0.0305), higher indexed LA volume on the CTA scan and on the HD‐EAM (p = 0.0223 and p = 0.0064, respectively), or higher indexed RA volume on the HD‐EAM (p = 0.0026). High RA diseased tissue burden predicted the presence of high LA diseased tissue burden (OR = 7.1, CI (95%): 1.3–38.9, p = 0.0145), and there was a significant correlation of the same (r = 0.6461, p < 0.0001). Conclusions Determining the extent of the right atrial low-voltage burden might give useful clinical information. According to our results, the diseased tissue burden correlates well between the two atria: the right atrium mirrors the left atrium.
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20
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Soulat-Dufour L, Lang S, Ederhy S, Ancedy Y, Beraud AS, Adavane-Scheuble S, Chauvet-Droit M, Hammoudi N, Scheuble A, Nhan P, Charbonnier M, Boccara F, Cohen A. Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight. Arch Cardiovasc Dis 2019; 112:585-593. [PMID: 31540880 DOI: 10.1016/j.acvd.2019.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial remodelling has been poorly investigated in atrial fibrillation (AF), and few studies have focused on biatrial remodelling. AIM To evaluate right atrial (RA) and left atrial (LA) remodelling in AF using global atrial reservoir strain and three-dimensional (3D) atrial volumes, according to rhythm outcome at mid-term follow-up. METHODS Two-dimensional and 3D transthoracic echocardiography (TTE) were performed within 24hours after admission (M0) and at 6-month follow-up (M6) in patients admitted for AF. RA and LA variables were assessed: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF); atrial expansion index (3D RAEI, 3D LAEI); and global RA and LA reservoir strain. RESULTS Forty-eight consecutive patients were included prospectively. Three groups were identified depending on rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) in 25 (52.1%) patients; AF at M0 and AF at M6 (AF-AF) in 13 (27.1%) patients; and SR at M0 (spontaneous cardioversion before first TTE) and SR at M6 (SR-SR) in 10 (20.8%) patients. Between M0 and M6 in the AF-SR group, we found: significant decreases in Max 3D RA Voli (P=0.020), Min 3D RA Voli (P=0.0008), Max 3D LA Voli (P=0.001) and Min 3D LA Voli (P=0.0021); significant increases in 3D RAEF (P=0.037) and 3D RAEI (P=0.034); no significant differences in 3D LAEF and 3D LAEI; and significant increases in global RA and LA reservoir strain (both P<0.0001). There was no significant difference with regard to these variables in the AF-AF and SR-SR groups. CONCLUSION 3D volume and strain analyses were useful in the evaluation of RA and LA reverse remodelling in successfully cardioverted patients with AF.
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Affiliation(s)
- Laurie Soulat-Dufour
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France
| | - Sylvie Lang
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Stephane Ederhy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Yann Ancedy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | | | - Saroumadi Adavane-Scheuble
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Marion Chauvet-Droit
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Nadjib Hammoudi
- Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France; Service de cardiologie, Sorbonne universités, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | | | - Pascal Nhan
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Magali Charbonnier
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Franck Boccara
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Inserm, UMR S 938, centre de recherche Saint-Antoine, 75012 Paris, France
| | - Ariel Cohen
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France.
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Sugumar H, Prabhu S, Voskoboinik A, Young S, Gutman SJ, Wong GR, Parameswaran R, Nalliah CJ, Lee G, McLellan AJ, Taylor AJ, Ling LH, Kalman JM, Kistler PM. Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy. JACC Clin Electrophysiol 2019; 5:681-688. [DOI: 10.1016/j.jacep.2019.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
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22
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Nery PB, Al Dawood W, Nair GM, Redpath CJ, Sadek MM, Chen L, Green MS, Wells G, Birnie DH. Characterization of Low-Voltage Areas in Patients With Atrial Fibrillation: Insights From High-Density Intracardiac Mapping. Can J Cardiol 2018; 34:1033-1040. [PMID: 30056843 DOI: 10.1016/j.cjca.2018.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/21/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND There is limited data on the scar burden in patients with atrial fibrillation (AF). In this study, we sought to evaluate the presence and extent of an abnormal left atrial (LA) substrate in patients with paroxysmal or persistent AF. METHODS Consecutive patients who underwent initial AF catheter ablation were prospectively enrolled. Endocardial voltage mapping was acquired in sinus rhythm using multipolar mapping catheters. Automated software was used to ensure homogeneous data collection. Assessment of low-voltage area (LVA) was performed by a reviewer blinded to clinical details. RESULTS One hundred and four patients were prospectively enrolled; 69 had paroxysmal and 35 persistent AF. The mean LA volume was 159 ± 48 mL, and the average number of LA points collected was 1308 ± 1065. Atrial LVAs were present in 23 of 69 (33%) subjects with paroxysmal and 20 of 35 (57%) with persistent AF (P = 0.02). Amongst 43 of 104 patients with scar, the average extent of LVA was 19.4 ± 21.6 cm2 and the mean percentage area was 7.6 ± 8.8%. Univariate analysis showed that age, LA volume, and persistent AF were associated with the presence of LVA. Multivariable analysis showed that age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.00-1.11; P = 0.046) and LA volume (OR 1.02; 95% CI 1.01-1.04; P < 0.001) remained predictors of LVA. AF classification (persistent vs paroxysmal) was not a predictor of an abnormal atrial substrate (OR 1.34; 95% CI 0.4-3.9; P = 0.56). CONCLUSIONS There is wide variability in the presence and extent of LVA in patients with paroxysmal or persistent AF. Age and LA volume were predictors of LVA. There was no correlation between AF classification and the presence of LVA.
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Affiliation(s)
- Pablo B Nery
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Wafa Al Dawood
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish M Nair
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Calum J Redpath
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mouhannad M Sadek
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Li Chen
- Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Martin S Green
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Wells
- Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David H Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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