Association of low-voltage areas with the regional wall deformation and the left atrial shape in patients with atrial fibrillation: A proof of concept study

Nedios, Sotirios; Sanatkhani, Soroosh; Oladosu, Michael; Seewöster, Timm; Richter, Sergio; Arya, Arash; Heijman, Jordi; Crijns, Harry J.G.M.; Hindricks, Gerhard; Bollmann, Andreas; Menon, Prahlad G.

doi:10.1016/j.ijcha.2021.100730

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…25 These pathophysiologic changes contribute to advanced remodeling and wall deformation that has been associated with LVA. 27 Our study supplement these findings of side specific pathophysiological LA changes (especially in relation to RAV) and emphasize the need for accurate pre-procedural LA assessment.…”

Section: Discussionsupporting

confidence: 78%

Biatrial volume ratio predicts low voltage areas in atrial fibrillation

Seewöster

Dinov

Nedios

et al. 2021

Clinical Cardiology

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Background: Left atrial volume (LAV) and low voltage areas (LVAs) are acknowledged markers for worse rhythm outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients.Objective: To investigate association between the LAV/RAV ratio and LVAs presence.Methods: Patients undergoing first AF ablation were included. LVAs were assessed periprocedurally using high-density 3D maps and defined as <0.5 mV. All patients underwent pre-procedural cardiovascular magnetic resonance imaging. LAV (biplane) and RAV (monoplane 4-chamber) were assessed prior to ablation, and the LAV/RAV ratio was calculated. Results:The study population included 189 patients (age mean 63 ± 10 years, 33% women, 57% persistent AF, 22% LVAs). There were 149 (79%) patients with LAV > RAV. In univariable analysis LAV > RAV was associated with LVAs (OR 6.803, 95%CI 1.395-26.514, p = .016). The association remained robust in multivariable model after adjustment for persistent AF, CHA 2 DS 2 -VASc score, and heart rate (OR 5.981,, p = .025). Using receiver operator curve analysis, LAV > RAV (AUC 0.668, 95%CI 0.585-0.751, p = .001) was significant predictor for LVAs. In multivariable analysis, after adjustment for age, persistent AF, and renal function, RAV≥LAV was threefold higher in males (OR 3.040, 95%CI 1.050-8.802, p = .04).Conclusions: LAV > RAV is useful for the prediction of electro-anatomical substrate in AF. LAV > RAV was associated with LVAs presence, while male sex remained associated with RAV≥LAV and less LVAs.

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Section: Discussionsupporting

confidence: 78%

Biatrial volume ratio predicts low voltage areas in atrial fibrillation

Seewöster

Dinov

Nedios

et al. 2021

Clinical Cardiology

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“…Although these measures can indicate deviation of the LA morphology from a perfect sphere, they do not specify how this deviation from sphereness is distributed. In atrial fibrillation, the freedom of arrhytmia recurrence after catheter ablation has been suggested to be associated with asymmetrical left atrial dilatation and regional left atrial wall deformity [ 23 , 24 ]. Regional deformities might further contribute to error in volume calculation by 2D methods.…”

Section: Discussionmentioning

confidence: 99%

Revisiting left atrial volumetry by magnetic resonance imaging: the role of atrial shape and 3D angle between left ventricular and left atrial axis

et al. 2021

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Background Accurate measurement of left atrial (LA) volumes is needed in cardiac diagnostics and the follow up of heart and valvular diseases. Geometrical assumptions with 2D methods for LA volume estimation contribute to volume misestimation. In this study, we test agreement of 3D and 2D methods of LA volume detection and explore contribution of 3D LA axis orientation and LA shape in introducing error in 2D methods by cardiovascular magnetic resonance imaging. Methods 30 patients with prior first-ever ischemic stroke and no known heart disease, and 30 healthy controls were enrolled (age 18–49) in a substudy of a prospective case–control study. All study subjects underwent cardiac magnetic resonance imaging and were pooled for this methodological study. LA volumes were calculated by biplane area-length method from both conventional long axis (LAVAL-LV) and LA long axis-oriented images (LAVAL-LA) and were compared to 3D segmented LA volume (LAVSAX) to assess accuracy of volume detection. 3D orientation of LA long axis to left ventricular (LV) long axis and to four-chamber plane were determined, and LA 3D sphericity indices were calculated to assess sources of error in LA volume calculation. Shapiro–Wilk test, Bland–Altman analysis, intraclass and Pearson correlation, and Spearman’s rho were used for statistical analysis. Results Biases were − 9.9 mL (− 12.5 to − 7.2) for LAVAL-LV and 13.4 (10.0–16.9) for LAVAL-LA [mean difference to LAVSAX (95% confidence interval)]. End-diastolic LA long axis 3D deviation angle to LV long axis was 28.3 ± 6.2° [mean ± SD] and LA long axis 3D rotation angle to four-chamber plane 20.5 ± 18.0°. 3D orientation of LA axis or 3D sphericity were not correlated to error in LA volume calculation. Conclusions Calculated LA volume accuracy did not improve by using LA long axis-oriented images for volume calculation in comparison to conventional method. We present novel data on LA axis orientation and a novel metric of LA sphericity and conclude that these measures cannot be utilized to assess error in LA volume calculation. Trial registration Main study Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) has been registered previously.

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“…The phase 1 prospective „FIbrosis Biomarker Mirroring Atrial fibRillation severity as a Key of aging (FIB-MARK)“ trial published by Kawaji et al [9] teamed an inflammatory protein array of peripheral blood from AF patients with assessment of atrial low voltage zone (LVZ). This surrogate fibrosis index was around the same time validated in a proof-of-concept study by Nedios et al [10] as the best indirect measure of atrial remodeling in patients undergoing AF ablation. In the report by Kawaji et al, interleukin (IL)-17A and interferon (IFN)-γ, respectively, showed the strongest positive and negative correlation with LVZ, suggesting that a raised serum IL-17A/IFN-γ ratio might be of predictive value – and possibly causal relevance – during AF evolution.…”

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confidence: 82%