Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes

Nedios, Sotirios; Koutalas, Emmanuel; Sommer, Philipp; Arya, Arash; Rolf, Sascha; Husser, Daniela; Bollmann, Andreas; Hindricks, Gerhard; Breithardt, Ole A.

doi:10.1093/europace/euw225

Cited by 20 publications

(17 citation statements)

References 19 publications

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“…Since ASI was not an independent predictor of the U‐pattern, we hypothesize that these two remodeling surrogates share a parallel pathophysiological process with common causes. This is further supported by our recent findings that emphasize the pathophysiological importance of diastolic dysfunction (LVDD) on the asymmetric LA remodeling 11 . Similarly, this study found that after adjusting for gender and U‐pattern, the only independent predictor of ASI was LVDD, probably representing a common pathway of the electromechanic and anatomical remodeling.…”

Section: Discussionsupporting

confidence: 86%

“…The intra and interobserver correlation coefficients were ≥0.90 as previously reported 11 . AF patients with a U‐pattern (n = 66) had increased LA asymmetry (ASI 65 ± 6 vs. 61 ± 3%, p = .014), older age (61 ± 11 vs. 51 ± 11 years, p = .03) and more diastolic dysfunction (71 vs. 22%, p = .008), associated with an increased E/A ratio (1.3 ± 0.4 vs. 1.0 ± 0.3, p = .08), than those with a D‐pattern.…”

Section: Resultssupporting

confidence: 81%

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Left atrial activation and asymmetric anatomical remodeling in patients with atrial fibrillation: The relation between anatomy and function

Nedios

Löbe

Knopp

et al. 2020

Clinical Cardiology

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BackgroundIdentifying patients with advanced left atrial (LA) remodeling before catheter ablation (CA) of atrial fibrillation (AF) is crucial.HypothesisThis study aimed to identify echocardiographic parameters associated with changes in anatomy and conduction properties of the left atrium (LA).MethodsWe examined 75 AF patients prior to CA and measured the intervals from the P‐wave‐onset to four mitral annulus sites by pulsed‐wave tissue Doppler imaging (PW‐TDI). Patients were grouped to an upward U‐pattern (delayed anterior activation) and a downward D‐pattern (earliest LA activation anterior). CT‐data were used to measure the LA volume (LAV). LAV was divided into anterior‐ (LA‐A) and posterior‐parts by a plane, parallel to the posterior wall and between the veins and the appendage, to calculate the asymmetry index (ASI = LA‐A/LAV).ResultsPatients with U‐pattern (n = 66) had a higher ASI (65 ± 6 vs. 61 ± 3%, p = .014), older age (61 ± 11 vs. 51 ± 11 years, p = .03) and more diastolic dysfunction (71 vs. 22%, p = .008) Multivariate regression showed that age (OR 1.1 per year, CI 1.007–1.199) and diastolic dysfunction (OR 6.36, CI 1.132–35.7, p = .036) were independent predictors of the U‐pattern. Diastolic dysfunction (B 4.49, CI 1.61–7.37, p = .003) was the only independent predictor of ASI in linear regression analysis.ConclusionAF patients with a U‐pattern have an increased LA asymmetry. Diastolic dysfunction is a common cause of this LA activation and remodeling. Therefore, detection of a U‐pattern signifies patients with advanced AF and may facilitate selection for an appropriate ablation strategy.

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Section: Discussionsupporting

confidence: 86%

Section: Resultssupporting

confidence: 81%

Left atrial activation and asymmetric anatomical remodeling in patients with atrial fibrillation: The relation between anatomy and function

Nedios

Löbe

Knopp

et al. 2020

Clinical Cardiology

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“…1 B). [8] All the parameters were observed and measured from multiple angles by two radiologists after relevant training.…”

Section: Image Analysismentioning

confidence: 99%

Impact of Left Atrial Geometric Remodeling on Late Atrial Fibrillation Recurrence After Catheter Ablation

Guo

Yang

et al. 2021

Preprint

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Purpose: To quantitatively investigate the impact of left atrial (LA) geometric remodeling on atrial fibrillation (AF) recurrence after catheter ablation (CA).Methods: A retrospective analysis of 105 patients with AF who underwent coronary computed tomographic angiography before CA. Risk factors for AF recurrence were identified by multivariable logistic regression analysis and used to create a nomogram.Results: After at least 12 months of follow-up, 30 patients (29%) developed recurrent AF. Patients with recurrence had a higher LA volume, LA sphericity, and a lower LA ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that LA minimal volume index (LAVImin) (OR: 1.280, 95% CI: 1.027–1.594, P = 0.028), LA sphericity (OR: 1.268, 95% CI: 1.071–1.500, P = 0.006) and CHA2DS2-VASc score (OR: 1.326, 95% CI: 1.016–1.732, P=0.038) were independent predictors of AF recurrence. The combined model of the LA sphericity to the LAVImin substantially increased the predictive power for AF recurrence (area under the curve [AUC] = 0.736, 95% CI: 0.627–0.844, P < 0.001), with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.769 (95% CI: 0.666–0.872) and had good internal validity.Conclusion: The CHA2DS2-VASc score, LA sphericity, and LAVImin were significant and independent predictors of AF recurrence after CA. Furthermore, the nomogram had a better predictive capacity for AF recurrence.

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“…In particular, retrograde atrial wave to PV can be a sensitive predictor of elevated LA pressure, and a diastolic wave in PV can be an indicator of LV diastolic dysfunction [9,22]. Also, chronic LV diastolic dysfunction can lead to the anatomical and electrical remodeling of LA [23]. Therefore, it can be deduced that LV diastolic dysfunction might be related to PV remodeling.…”

Section: Pulmonary Vein: a Plausible Crosslink Between LV Diastolic Dmentioning

confidence: 99%

Pulmonary Vein Enlargement as an Independent Predictor for New-Onset Atrial Fibrillation

Kim

Lee

et al. 2020

JCM

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Pulmonary vein (PV) enlargement is associated with atrial fibrillation (AF). However, the predictive value of PV volume for new-onset AF has not been determined. We retrospectively assessed and enrolled non-AF subjects who underwent echocardiography and cardiac CT angiography (CCTA) around the same time and evaluated the development of AF longitudinally. PV volume was assessed by estimating the three-dimensional CCTA-derived mid-diastolic PV volume from the ostium to tertiary branches. Overall, 1105 subjects were enrolled. Among them, 29 developed AF during a mean follow-up of 4.28 ± 3.08 years after baseline CCTA and echocardiography. The AF group had a higher proportion of older aged subjects, a higher ratio of early mitral flow velocity (E) to early mitral annular tissue velocity (Em), higher Em, and larger left atrial (LAVI) and PV (PVVI) volume indices. PVVI was independently associated with male sex, left ventricular dimension, E/Em and LAVI. AF incidence increased markedly across each baseline PVVI tertile (2.2%, 5.1%, and 10.8%). In the multivariate Cox model, increased PVVI was independently associated with new-onset AF (hazard ratio (HR) = 5.401, 4.931–6.193, p = 0.007). Based on the analysis of multimodal cardiac imaging, our results provide mechanistic insights into PV remodeling and its potential role as a link between diastolic dysfunction and developing AF.

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Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes

Abstract: Left atrial symmetry changes are associated with DD and dilatation. Since DD could cause LA remodelling, appropriate early treatment should be considered for AF patients with DD, before geometrical changes occur.

Cited by 20 publications

References 19 publications

Left atrial activation and asymmetric anatomical remodeling in patients with atrial fibrillation: The relation between anatomy and function

Left atrial activation and asymmetric anatomical remodeling in patients with atrial fibrillation: The relation between anatomy and function

Impact of Left Atrial Geometric Remodeling on Late Atrial Fibrillation Recurrence After Catheter Ablation

Pulmonary Vein Enlargement as an Independent Predictor for New-Onset Atrial Fibrillation

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