Introduction Although catheter ablation (CA) for atrial fibrillation (AF) is commonly used to improve symptoms, AF recurrence is common and new tools are needed to better inform patient selection for CA. Left Atrial Function Index (LAFI), an echocardiographic measure of atrial mechanical function, has shown promise as a non-invasive predictor of AF. We hypothesized that LAFI would relate to AF recurrence after CA. Methods and Results All AF patients undergoing index CA were enrolled in a prospective institutional AF Treatment Registry between 2011 and 2014. LAFI was measured post-hoc from pre-ablation clinical echocardiographic images in 168 participants. Participants were mostly male (33% female), middle-aged (60±10 years), obese and had paroxysmal AF (64%). Mean LAFI was 25.9±17.6. Over 12 months of follow-up, 78 participants (46%) experienced a late AF recurrence. In logistic regression analyses adjusting for factors known to be associated with AF, lower LAFI remained associated with AF recurrence after CA [OR 0.04 (0.01 – 0.67), p= 0.02]. LAFI discriminated AF recurrence after CA slightly better than CHADS2 (C-statistic 0.60 LAFI, 0.57 CHADS2). For participants with persistent AF, LAFI performed significantly better than CHADS2 score (C statistic= 0.79 LAFI, 0.56 CHADS2, p= 0.02). Conclusion LAFI, an echocardiographic measure of atrial function, is associated with AF recurrence after CA and has improved ability to discriminate AF recurrence as compared to the CHADS-2 score, especially among persistent AF patients. Since LAFI can be calculated using standard two-dimensional echocardiographic images, it may be a helpful tool for predicting AF recurrence.

Introduction: Genetic and transcriptomic factors play important roles as mediators of new-onset and recurrent atrial fibrillation (AF). MicroRNAs (miRNAs) regulate expression of gene networks involved in key aspects of atrial remodeling. Associations between circulating miRNAs and AF recurrence are unknown. We tested the hypothesis that cardiac miRNAs associated with electrical and structural remodeling predict recurrent AF rhythm in post-ablation patients.

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BackgroundBedside ultrasound helps to estimate volume status in critically ill patients and has traditionally relied on diameter, respiratory variation, and collapsibility of the inferior vena cava (IVC) to reflect fluid status. We evaluated collapsibility of the internal jugular vein (IJ) with ultrasound and correlated it with concomitant right heart catheterization (RHC) measurements in patients with presumed pulmonary hypertension.Methods and resultsWe studied 71 patients undergoing RHC for evaluation of pulmonary hypertension. Using two-dimensional ultrasound (Sonosite, Washington, USA), we measured the diameter of the IJ at rest, during respiratory variation, and during manual compression. Collapsibility index during respiration (respiratory CI) and during manual compression (compression CI) was calculated. We correlated mean right atrial pressure (mRAP) and pulmonary artery occlusion pressure (PAOP) defined by RHC measurements with respiratory and compression CI. A secondary goal was examining correlations between CI calculations and B-type natriuretic peptide (BNP) levels. Baseline characteristics demonstrated female predominance (n = 51; 71.8%), mean age 59.5 years, and BMI 27.3. There were significant correlations between decrease in compression CI and increase in both mRAP (Spearman: − 0.43; p value = 0.0002) and PAOP (Spearman: − 0.35; p value = 0.0027). In contrast, there was no significant correlation between respiratory CI and either mRAP (Spearman: − 0.14; p value = 0.35) or PAOP (Spearman:− 0.12; p value = 0.31). We also observed significant negative correlation between compression CI and BNP (Spearman: − 0.31; p value = 0.01) but not between respiratory CI and BNP (Spearman: − 0.12; p value = 0.35).ConclusionIncreasing use of ultrasound has led to innovative techniques for estimating volume status. While prior ultrasound studies have used clinical parameters to estimate fluid status, our study used RHC measurements and demonstrated that compression CI potentially reflects directly measured mRAP and PAOP.

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