Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation

Abstract

Background Symptomatic left atrial (LA) flutter (LAFL) is common following atrial fibrillation (AF) ablation. Objective To examine the association of baseline LA function with incident LAFL following AF ablation. Methods The source cohort included 216 patients with cardiac magnetic resonance (CMR) prior to initial AF ablation between 2010 and 2013. Patients who underwent cryoballoon or laser ablation, patients with AF during CMR, and those with suboptimal CMR, or missing follow-up data were excluded. Baseline LA volume and function were assessed by feature-tracking CMR analysis. Results The final cohort included 119 patients (age 58.9±11 years, 76.5% male, 70.6% paroxysmal AF). During a median follow-up of 421 (interquartile range 235–751) days, 22 (18.5%) patients developed LAFL. Baseline LA volume was similar between the two groups. In contrast, baseline reservoir, conduit and contractile function of the LA were significantly impaired in patients with incident LAFL. Baseline global peak longitudinal atrial strain (PLAS) < 22.65% predicted incident LAFL with 86% sensitivity and 68% specificity (C-statistic 0.76). In a multivariable model adjusting for age, heart failure, and LA volume, PLAS (HR 0.9 per % increase in PLAS, p=0.003) and LA linear lesions (HR 2.94, p=0.020) were independently associated with incident LAFL. Coexistence of PLAS<22.65% and linear lesions was associated with 9-fold increased hazard of incident LAFL. Conclusion Baseline LA function and linear lesions were independently associated with incident LAFL after AF ablation. Linear lesions should be limited to selected cases, especially in patients with impaired LA function.

Prevalence and predictive factors of left atrial tachycardia occurring after second‐generation cryoballoon ablation of atrial fibrillation

“…When circumferential pulmonary vein ablation includes lines, the prevalence is clearly higher in all studies, ranging from 10 to 31%. Lines were recently confirmed to be a predictive factor of LAT after atrial fibrillation ablation …”

“…Persistent atrial fibrillation, additional linear lesions in the LA, ablation gaps, and left atrial function have been identified as predictors of AT after RF ablation. Persistent atrial fibrillation was not a predictor in our study.…”

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

“…The reported experience of using FT-CMR LA strain parameter assessment for clinical diagnosis is quite recent, and encompasses cohorts of patients undergoing atrial fibrillation catheter ablation [ 8 , 47 , 48 ], implantable cardioverter-defibrillator implant [ 47 , 49 ], community volunteers without cardiovascular disease at baseline [ 50 , 51 ], patients with acute myocarditis [ 45 ], obesity [ 52 ], and Ebstein’s anomaly [ 53 ]. These studies established the feasibility and validity of LA strain parameter measurement using CMR; and in [ 51 ] found negative correlation between LA strain and LA fibrosis.…”

Ablation of Left Atrial Tachycardia following Catheter Ablation of Atrial Fibrillation: 12-Month Success Rates

“…Left atrial tachycardia most commonly occurs after previous cardiac surgery or catheter ablation of atrial fibrillation (AF), but it can also be idiopathic. The reported prevalence of AT after AF catheter ablation (CA) ranges from 2% to 20% [3][4][5] and is mostly associated with structural heart disease [3]. Although external cardioversion (CV) and medical rate control are recommended by the recent ACC/AHA/HRS guidelines for acute treatment, relapse rates after CV are high [6].…”