Left Atrial Stiffness, a Marker of Atrial Cardiomyopathy, and Atrial Fibrillation -
            Relationships and Predictors for Procedure Success after Catheter Ablation

Wu, Tan Chen

doi:10.5935/abc.20190087

Cited by 5 publications

(6 citation statements)

References 11 publications

(12 reference statements)

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“…Atrial fibrillation has a strict relationship with atrial structural remodeling and is often associated with fibrosis/scarring and dilatation. Substrate progression is a multifactorial and time-dependent response of cardiac myocytes to several electrical, mechanical, and metabolic “stressors” [ 12 ]. Several risk factors have a causal relationship with AF by causing structural remodeling.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, AF itself can lead to a significant progression of the substrate. In addition to complexion-channel remodeling that accelerates repolarization and alters conduction properties, rapid activation of atrial cardiomyocytes results in pro-fibrotic changes in fibroblast function promoting atria fibrosis [ 12 ]. Increased LA scar is also associated with increases LA stiffness resulting in a deteriorated reservoir function.…”

Section: Discussionmentioning

confidence: 99%

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Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort

Manfrin

Mugnai

Rauhe

et al. 2021

JCM

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Aims: The clinical role of the left atrial (LA) hypertension in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyze the role of LA pressure in patients with nonvalvular AF who underwent PV isolation and its implication for AF catheter ablation. Methods: Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were included in this analysis. Results: A total of 132 consecutive patients (97 males, 73%; mean age 58.0 ± 13.2 years) were included in the analysis. Eleven patients (8%) underwent radiofrequency ablation and 121 (92%) cryoballoon ablation. Higher LA pressures were found in 54 patients (40.9%). At a mean follow up of 14.3 ± 8.2 months (median 12 months), the success rate without antiarrhythmic therapy was 65.9% (87/132; considering the blanking period). Female gender and continuous mean LA pressure were significantly associated with AF recurrence and remained significant on multivariable Cox analysis (respectively, HR 1.845, 1.00–3.40, p = 0.05 and HR 1.066, 1.002–1.134, p = 0.04). We identified a LA mean pressure of >15 mmHg as ideal cutoff and constructed a model to predict AF recurrence which fitted with a concordance index (C-index) of 0.65 (95% CI 0.56–0.75), logrank score p = 0.003.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort

Manfrin

Mugnai

Rauhe

et al. 2021

JCM

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“…Moreover, LA strain at reservoir phase pre dicts maintenance of sinus rhythm after ablation in both paroxysmal and persistent AF forms: the lack of a significant increase of global PALS after the procedure suggest the possibility of new episodes of arrhythmia (33). Bearing that this intervention is not free of risks, accurate selection of patients is essential, and LA strain would be of great utility to identify patients with high risk of AF recurrence, as shown in a recent meta-analysis including 8 studies (34).…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Left atrial strain in cardiovascular diseases : An overview of clinical applications

Pastore¹,

Mandoli²,

Santoro³

et al. 2021

Cardiologia Hungarica

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“…The concept of AC has been translated not only to cardiovascular imaging, but also to inform decision-making in interventional electrophysiology procedures. First, regarding the substrate for AF ablation, substrate progression is now seen as a multifactorial response of cardiomyocytes to electrical, mechanical, and metabolic stressors (77). While some components of these changes to the LA are reversible (or adaptive), others such as progressive fibrosis are more permanent, or maladaptive (77).…”

Section: Ac In Electrophysiology Studies and Ep Interventionsmentioning

confidence: 99%

“…First, regarding the substrate for AF ablation, substrate progression is now seen as a multifactorial response of cardiomyocytes to electrical, mechanical, and metabolic stressors (77). While some components of these changes to the LA are reversible (or adaptive), others such as progressive fibrosis are more permanent, or maladaptive (77). Currently, there is a lack of standard techniques to preoperatively assess the degree of atrial fibrosis and to identify the potential rotors for AF, which could theoretically improve the results of catheter ablation, especially in patients with longstanding and persistent AF (78).…”

Section: Ac In Electrophysiology Studies and Ep Interventionsmentioning

confidence: 99%

Atrial Cardiomyopathy: An Unexplored Limb of Virchow's Triad for AF Stroke Prophylaxis

Darlington

McCauley

2020

Front. Cardiovasc. Med.

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The most dreaded complication of atrial fibrillation is stroke, and 70-80% of patients with AF-related stroke die or become disabled. The mechanisms of thromboembolism in AF are multifactorial, with evidence demonstrating that all three criteria of Virchow's triad are satisfied in AF: abnormal stasis of blood, endothelial damage, and hypercoagulability. Mechanistic insights into the latter two limbs have resulted in effective stroke prophylactic therapies (left atrial appendage occlusion and oral anticoagulants); however, despite these advances, there remains an excess of stroke in the AF population that may be due, in part, to a lack of mechanistic understanding of atrial hypocontractility resulting in abnormal stasis of blood within the atrium. These observations support the emerging concept of atrial cardiomyopathy as a cause of stroke. In this Review, we evaluate molecular, translational, and clinical evidence for atrial cardiomyopathy as a cause for stroke from AF, and present a rationale for further investigation of this largely unaddressed limb of Virchow's triad in AF.

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Left Atrial Stiffness, a Marker of Atrial Cardiomyopathy, and Atrial Fibrillation - Relationships and Predictors for Procedure Success after Catheter Ablation

Cited by 5 publications

References 11 publications

Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort

Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort

Left atrial strain in cardiovascular diseases : An overview of clinical applications

Atrial Cardiomyopathy: An Unexplored Limb of Virchow's Triad for AF Stroke Prophylaxis

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