Atrial Electrical and Structural Changes Associated with Longstanding Hypertension in Humans: Implications for the Substrate for Atrial Fibrillation

Abstract

PVAI is an effective strategy for the prevention of AF in the majority of patients with PAF. Maintenance of SR requires repeat procedure or continuation of AADs in a significant proportion of patients. After maintenance of sinus rhythm 1-year post-PVAI, a minority of patients will subsequently develop late recurrence of AF.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…Similar findings have been reported in each of the subsequent trials. 266,267,268,1022,1086,1087 The predictors of late recurrence most commonly identified include persistent AF as well as comorbid conditions. Despite the low single-procedure, long-term success rate reported in virtually all of these clinical trials, they also reveal that with the use of repeat AF ablation procedures and/or AAD therapy, much higher rates of freedom from recurrent AF as well as concomitant reductions in AF burden can be achieved.…”

Reverse cardiac remodeling after renal denervation: Atrial electrophysiologic and structural changes associated with blood pressure lowering

“…Assessment of complex electrograms included assessment of fractionated signals (electrograms with ≥50ms duration with at least 3 deflections) as previously described 4 .…”

“…Conduction velocity (CV) was assessed on the isochronal activation map, assessing the velocity of wave-front propagation at regions of least isochronal crowding, averaging CV measured from 5 pairs of electrograms at each region, as previously described 4 .…”

Ablation of long-standing persistent atrial fibrillation

“…Not surprisingly, the relationship between average systolic blood pressure and AF is stronger for persistent AF compared to paroxysmal AF (28). The atrial remodeling that is associated with systemic hypertension has been also characterized by global conduction slowing, regional conductional delays and increased AF inducibility (29). Mahnkopf et al compared LA structural changes in lone AF patients to the patients with common conditions like hypertension, diabetes mellitus, congestive heart failure, stroke and coronary artery disease through delayed enhancement magnetic resonant imaging (DE-MRI) (30).…”