Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

Abstract

Background-Atrial fibrillation (AF) is associated with significant abnormalities of left atrial (LA) systolic and diastolic function. This study describes a novel measure, LA stiffness index, that estimates LA diastolic function and its association with clinical outcomes of catheter ablation. Methods and Results-A total of 219 AF patients referred for ablation (59% paroxysmal, mean CHA 2 DS 2 VASc score 1.7±1.4) were enrolled. Atrial pressure and volume loops were prepared from invasive pressure measures and cardiac magnetic resonance imaging volumetric data during sinus rhythm for all patients. An LA stiffness index was created, defined by the ratio of change in LA pressure to volume during passive filling of LA (ΔP/ΔV). Patients were followed prospectively. Mean LA stiffness index for AF patients was 0.6±0.5 mm Hg/mL (paroxysmal AF 0.51±0.4 and persistent AF 0.73±0.6; P<0.001). Linear regression analysis showed a rise in the stiffness index with age, increasing at a rate of 0.02 mm Hg/mL per year (P<0.001). The LA stiffness index was higher in patients with previous LA ablation(s) for AF (0.51±0.35 versus 0.83±0.70; P<0.001). Forty of 160 patients had recurrence after AF ablation with a mean follow-up of 10.4±7.6 months. Patients with recurrence had higher stiffness index than those without recurrence (0.83±0.46 versus 0.40±0.22; P<0.001). Conclusions-LA stiffness index, a novel measure to assess LA diastolic function, increases with age and is higher in persistent AF and in the setting of repeat AF ablation. Greater LA stiffness index was independently associated with recurrence of AF after LA ablation. (Circ Arrhythm Electrophysiol. 2016;9:e003163.

Aging Modulates the Substrate and Triggers Remodeling in Atrial Fibrillation

“…25 The elevated LA pressure secondary to increased LA stiffness in the setting of diffuse LA fibrosis might be associated with AF recurrence. 26 Therefore, aging-induced structural changes contribute significantly to the pathophysiology of AF.…”

Geographic and racial representation and reported success rates of studies of catheter ablation for atrial fibrillation: Findings from the SMASH‐AF meta‐analysis study cohort

“…Over half of the PAF and NPAF treatment arms were conducted in 5 and 3 countries, respectively (PAF: Germany, N = 42, Japan, N = 39, China, N = 34, Turkey, N = 19, United States, N = 19; NPAF: United States, N = 35, China, N = 15, Germany, N = 15). Race or ethnicity demographics were reported in only one study (0.3%) with limited diversity (86% white), while no studies reported race or ethnicity‐stratified outcomes. Seventeen PAF and 16 NPAF treatment arms (PAF: 12 studies; NPAF: 15 studies) were performed in countries with less than four total country treatment arms and were excluded from success rate analyses (PAF: Austria, N = 1, Brazil, N = 1, Canada, N = 2, Hungary, N = 2, Israel, N = 2, Norway, N = 2, Poland, N = 2, Portugal, N = 1, Spain, N = 3, United Kingdom, N = 1; NPAF: Australia, N = 1, Belgium, N = 1, Denmark, N = 1, France, N = 1, Ireland, N = 1, Netherlands, N = 3, Norway, N = 1, Switzerland, N = 1, Turkey, N = 3, Taiwan, N = 1, United Kingdom, N = 2).…”

MRI use for atrial tissue characterization in arrhythmias and for EP procedure guidance

“…It has also recently become possible to use motion-tracking post-processing (a method borrowed from cardiac ultrasound) of retrospectively-gated multiple-cardiac-phase balanced Steady State Free Precession (cine) imaging to obtain strain images of the atrium 51, 52 , although the spatial resolution of these images is lower than obtained with the traditional MRI methods used to acquire strain (DENSE, HARP, or phase-contrast).…”