Comparison of Pulmonary Venous and Left Atrial Remodeling in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy Versus With Hypertensive Heart Disease

Yoshida, Kentaro; Hasebe, Hideyuki; Tsumagari, Yasuaki; Tsuneoka, Hidekazu; Ebine, Mari; Uehara, Yoshiko; Seo, Yoshihiro; Aonuma, Kazutaka; Takeyasu, Noriyuki

doi:10.1016/j.amjcard.2016.12.025

Cited by 6 publications

(7 citation statements)

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“…PV dilation may be a consequence of structural remodeling associated with PV stretch due to left ventricular diastolic dysfunction and inflammation due to persistence of AF and epicardial adipose tissue. 11 , 18 These factors and the resulting fibrosis could directly and indirectly affect epicardial fibers and the LA and PV sleeve. In the remodeled and dilated PVs, conduction through the Marshall bundle could be pathologically diminished, and initial ablation lesion sets encircling the PVs could be more likely to abolish the Marshall bundle conduction than in the less remodeled and smaller PVs.…”

Section: Discussionmentioning

confidence: 99%

“… Minor- and major-axis diameters of each PV ostium (mm/m 2 ). 11 , 12 Circumferences at the ostium level (mm/m 2 ). 11 , 12 Cross-sectional area.…”

Section: Methodsmentioning

confidence: 99%

“… 11 , 12 Circumferences at the ostium level (mm/m 2 ). 11 , 12 Cross-sectional area. 13 , 14 This was calculated according to the following formula: π × (major axis / 2) × (minor axis / 2).…”

Section: Methodsmentioning

confidence: 99%

“…Minor- and major-axis diameters of each PV ostium (mm/m 2 ). 11 , 12 …”

Section: Methodsmentioning

confidence: 99%

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Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins

et al. 2020

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BACKGROUND Ablation of the pulmonary vein (PV) carina is occasionally required for PV isolation (PVI). Marshall bundle and epicardial connections between the right-sided PV (RtPV) carina and right atrium (RA) may be one of the mechanisms that necessitates carina ablation.OBJECTIVE We sought to clarify anatomical characteristics predictive of the necessity of carina ablation.METHODS Forty-five consecutive patients undergoing radiofrequency catheter ablation of atrial fibrillation were prospectively included in this study. Left atrial (LA) and PV size and morphology, and interatrial distance in the posterior aspect, were measured on cardiac computed tomography (CT) images.RESULTS For right-sided PVI, the patients were divided into 2 groups based on the necessity of RtPV carina ablation, Carina-ABL group (n 5 21) and Non-Carina-ABL group (n 5 24). The distance between the anterior portion of the RtPV carina and RA was shorter in the Carina-ABL group vs in the Non-Carina-ABL group (7.7 6 1.7 mm/m 2 vs 9.5 6 2.3 mm/m 2 ; P 5 .005), whereas other anatomical parameters (LA and RA volumes, right inferior PV angle, and ostial diameters of the RtPVs) did not differ between the groups. For leftsided PVI, the ostial diameter and circumference of the left superior PV were smaller in the Carina-ABL group (n 5 13) vs the Non-Carina-ABL group (n 5 32) (8.6 6 2.1 mm/m 2 vs 7.3 6 1.5 mm/m 2 ; P 5 .044, and 34.9 6 6.0 mm/m 2 vs 30.1 6 5.1 mm/m 2 ; P 5 .017, respectively).CONCLUSIONS A shorter interatrial distance for right-sided PVI and a smaller PV ostium for left-sided PVI were associated with the necessity of additional carina ablation. The presence and location of the epicardial fibers may be affected by the atrial and PV geometry.

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Section: Discussionmentioning

confidence: 99%

“… Minor- and major-axis diameters of each PV ostium (mm/m 2 ). 11 , 12 Circumferences at the ostium level (mm/m 2 ). 11 , 12 Cross-sectional area.…”

Section: Methodsmentioning

confidence: 99%

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Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins

et al. 2020

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“…The asymmetric LA dilatation found in our study underscores the interaction between left ventricle and left atrium, especially during diastole, when LA is directly exposed to LV pressures. HCM is commonly accompanied by diastolic dysfunction and myocardial fibrosis that results in increased LA pressures and progressive chamber enlargement 22 , 23 . This is further supported by our recent findings that emphasize the pathophysiological importance of diastolic dysfunction on the asymmetric LA remodeling in patients without HCM 12 .…”

Section: Discussionmentioning

confidence: 99%

Characteristics of left atrial remodeling in patients with atrial fibrillation and hypertrophic cardiomyopathy in comparison to patients without hypertrophy

Nedios

Dinov

Seewöster

et al. 2021

Sci Rep

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Atrial fibrillation (AF) leads to remodeling characterized by changes in both size and shape of the left atrium (LA). Here we aimed to study the effect of hypertrophic cardiomyopathy (HCM) on the pattern of LA remodeling in AF-patients. HCM-patients (n = 23) undergoing AF ablation (2009–2012) were matched and compared with 125 Non-HCM patients from our prospective registry. Pre-procedural CT data were analyzed (EnSite Verismo, SJM, MN) to determine the maximal sagittal (anterior–posterior, AP), coronal (superior-inferior, SI and transversal, TV) dimensions and the sphericity index (LAS). Volume (LAV) was rendered after appendage (LAA) and pulmonary vein (PV) exclusion. A cutting plane, between PV ostia/LAA and parallel to the posterior wall, divided LAV into anterior- (LAA) and posterior-LA (LAP) parts. The ratio LA-A/LAV was defined as asymmetry index (ASI). HCM patients had a wider inter-ventricular septum and a smaller LV than Non-HCM patients. LA volume (LAV 166 ± 72 vs. 130 ± 36 ml, p = 0.03) and LA diameters were significantly larger in HCM patients. Anterior volume (LA-A: 112 ± 48 vs. 83 ± 26 ml, p < 0.001) differed significantly between groups, whereas the posterior volume LA-P (55 ± 28 vs. 47 ± 13 ml, p = 0.23) and LAS (75% vs. 78%, p = 0.089) was similar in both groups. As a result, ASI was significantly higher (67 ± 6 vs. 63 ± 6%, p = 0.01) in HCM than in Non-HCM patients. In conclusion, LA remodeling in patients with AF and HCM is characterized by asymmetric dilatation, driven by an anterior rather than a posterior dilatation. This can be characterized by three-dimensional imaging and could be used as surrogate of advanced atrial remodeling.

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Clinical and pathophysiologic determinants of catheter ablation outcome in hypertrophic cardiomyopathy with atrial fibrillation

Lee,

Cho,

Choi

et al. 2024

Journal of Arrhythmia

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BackgroundHypertrophic cardiomyopathy (HCM) is frequently associated with atrial fibrillation (AF). We compared clinical, echocardiographic, and electrophysiological parameters between HCM subtypes and those without HCM at AF catheter ablation (AFCA) and analyzed post‐AFCA reverse remodeling and AF recurrence based on HCM presence and subtype.MethodsAmong 5161 consecutive patients who underwent de novo AFCA, we included HCM patients and control patients who were age‐, gender‐, and AF type‐matched. Between AF‐HCM patients and controls, we compared baseline values for left atrium (LA) wall thickness (LAWT), reverse remodeling at 1‐year follow‐up, and procedural outcomes over the course of follow‐up between two groups.ResultsA total of 122 AF‐HCM patients and 318 control patients were included. AF‐HCM patients had more frequent heart failure and higher LA diameter, E/Em, and LA pressure (all, p < .001). However, LAWT did not differ from control group. A year after AFCA, degree of LA reverse remodeling was significantly lower in AF‐HCM than in control group (ΔLA dimension, p = .025). Nonapical HCM (HR 1.71; 95% CI 1.05–2.80), persistent AF (HR 1.46; 95% CI 1.05–2.04), and LA dimension (HR 1.04; 95% CI 1.01–1.06) were independent risk factors for AF recurrence. During 78.0 months of follow‐up, nonapical HCM patients showed higher AF recurrence rate than both apical HCM (log‐rank p = .005) and control patients (log‐rank p = .002).ConclusionsThe presence of HCM, particularly nonapical HCM, displayed increased LA hemodynamic loading with diastolic dysfunction and had poorer rhythm outcomes after AFCA compared to both apical HCM and control group.

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Comparison of Pulmonary Venous and Left Atrial Remodeling in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy Versus With Hypertensive Heart Disease

Cited by 6 publications

References 26 publications

Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins

Interatrial distance predicts the necessity of additional carina ablation to isolate the right-sided pulmonary veins

Characteristics of left atrial remodeling in patients with atrial fibrillation and hypertrophic cardiomyopathy in comparison to patients without hypertrophy

Clinical and pathophysiologic determinants of catheter ablation outcome in hypertrophic cardiomyopathy with atrial fibrillation

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