Age and sex differences in atrial fibrosis among patients with atrial fibrillation

Akoum, Nazem; Mahnkopf, Christian; Kholmovski, Eugene; Brachmann, Johannes; Marrouche, Nassir F.

doi:10.1093/europace/eux260

Cited by 96 publications

(80 citation statements)

References 18 publications

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“…As seen in previous single center studies, the analysis of the German ablation registry also revealed female sex as well as long standing persistent AF as independent predictors for AF recurrence after an initially successful CA 3 , 10 , 22 . Female sex has been described as and an independent risk factor for recurrence of AF after CA of AF 10 , 23 , 24 , in accordance a recent MRI study revealed that female sex is associated with a higher burden of atrial fibrosis in patients with AF and therefore increasing AF recurrence 25 .…”

Section: Discussionmentioning

confidence: 71%

Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry

Sultan

Lüker

Andresen

et al. 2017

Sci Rep

119

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Catheter ablation (CA) for atrial fibrillation (AF) has emerged as a widespread first or second line treatment option. However, up to 45% of patients (pts) show recurrence of AF within 12 month after CA. We present prospective multicenter registry data comparing characteristics of pts with and without recurrence of AF within the first year after CA. This study comprises all pts with complete follow-up one year after CA (1-y-FU; n = 3679). During 1y-FU in 1687 (45.9%) pts recurrence of AF occurred. The multivariate analysis revealed female sex and AF type prior to the procedure as predictors for AF recurrence. Furthermore, comorbidities such as valvular heart disease and renal failure as well as an early AF relapse were also predictors of AF recurrence during 1-y-FU. However, despite an AF recurrence rate of 45.9%, the majority of these pts (72.4%) reported a significant alleviation of clinical symptoms. In conclusion in pts with initially successful CA for AF female sex, AF type, in-hospital AF relapse and comorbidities such as renal failure and valvular heart disease are independent predictors for AF recurrence during 1-y-FU. However, the majority of pts deemed their interventions as successful with significant reduction of symptoms irrespective of AF.

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Section: Discussionmentioning

confidence: 71%

Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry

Sultan

Lüker

Andresen

et al. 2017

Sci Rep

119

View full text Add to dashboard Cite

show abstract

“…[ 142 ] An additional analysis of the Utah dataset found that women had a higher rate of fibrosis than men (17.5% versus 15.3%; p<0.01) which may explain the increased stroke risk in women with AF (prior stroke prevalence 15.8% versus 6.5%; p<0.001). [ 143 ] Moreover, in a prospective study of 111 patients with ischemic stroke, patients with a cryptogenic stroke after extensive stroke workup were found to have a statistically significantly higher percentage of LA fibrosis than patients with a known cause excluding AF (LA fibrosis percentage: median 18%, IQR 16% versus median 10.5%, IQR 16%; p=0.03). Patients with an unknown cause had a similar percentage of fibrosis compared with those with AF as cause (median 18%, IQR 16% versus median 25%, IQR 21%; p=0.22).…”

Section: Clinical Evaluation Of Myopathymentioning

confidence: 99%

Atrial Myopathy Underlying Atrial Fibrillation

Rivner

Mitrani

Goldberger

2020

Arrhythmia &Amp; Electrophysiology Review

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While AF most often occurs in the setting of atrial disease, current assessment and treatment of patients with AF does not focus on the extent of the atrial myopathy that serves as the substrate for this arrhythmia. Atrial myopathy, in particular atrial fibrosis, may initiate a vicious cycle in which atrial myopathy leads to AF, which in turn leads to a worsening myopathy. Various techniques, including ECG, plasma biomarkers, electroanatomical voltage mapping, echocardiography, and cardiac MRI, can help to identify and quantify aspects of the atrial myopathy. Current therapies, such as catheter ablation, do not directly address the underlying atrial myopathy. There is emerging research showing that by targeting this myopathy we can help decrease the occurrence and burden of AF.

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“…In currently published data on the prevalence of atrial fibrosis in patients with AF, advancing age and female sex have been identified to be predictors of atrial fibrosis [29]. Similarly, female sex and advancing age were more frequent in patients with extensive LVAs in the examined cohort.…”

Section: Discussionmentioning

confidence: 74%

TGFβ Is Specifically Upregulated on Circulating CD14++ CD16+ and CD14+ CD16++ Monocytes in Patients with Atrial Fibrillation and Severe Atrial Fibrosis

Heinzmann

Fuss

Ungern-Sternberg

et al. 2018

Cell Physiol Biochem

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Background/Aims: Fibrotic remodeling of the atria plays a key role in the pathogenesis of atrial fibrillation (AF). As little is known about the contribution of circulating monocytes in atrial remodeling and the pathophysiology of AF, we investigated profibrotic factors in different subsets of circulating monocytes obtained from patients with atrial fibrillation undergoing catheter ablation. Methods: A 3D high density voltage mapping was performed in sinus rhythm to evaluate the extent of low-voltage areas (LVAs) in the atria of 71 patients with persistent AF. Low-voltage was defined as signals of < 0.5mV during sinus rhythm. Prior to ablation, blood was drawn and monocytes were analyzed by FACS. Based on the expression of CD14 and CD16, three subgroups including CD14⁺⁺ CD16^- (‘classical’), CD14⁺⁺ CD16⁺ (‘intermediate’), and CD14⁺ CD16⁺⁺ (‘non-classical’) were analyzed for the expression of TGFb, CD147, and MMP-9, representing pivotal profibrotic pathways in myocardial remodeling. Results: Expression of TGFb was increased in CD14⁺ monocytes of patients with extensive LVAs compared to patients with a low extend of LVAs. While CD14⁺⁺ CD16^- monocytes showed no difference, CD14⁺⁺ CD16⁺ and CD14⁺ CD16⁺⁺ monocytes showed a strong increase of TGFb abundance. Although CD147 and MMP-9 are strongly associated with myocardial fibrosis, we found no difference in expression between the two groups in any monocyte subsets. Conclusion: TGFb is specifically upregulated on CD14⁺⁺ CD16⁺ and CD14⁺ CD16⁺⁺ monocytes in patients with extensive LVAs undergoing catheter ablation.

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Age and sex differences in atrial fibrosis among patients with atrial fibrillation

Cited by 96 publications

References 18 publications

Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry

Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry

Atrial Myopathy Underlying Atrial Fibrillation

TGFβ Is Specifically Upregulated on Circulating CD14++ CD16+ and CD14+ CD16++ Monocytes in Patients with Atrial Fibrillation and Severe Atrial Fibrosis

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