Different Patterns of Atrial Remodeling After Catheter Ablation of Chronic Atrial Fibrillation

Lo, Li‐Wei; Tsao, Hsuan‐Ming; Lin, Yenn‐Jiang; Chang, Shih‐Lin; Hu, Yu‐Feng; Tsai, Wen-Chin; Tuan, Ta-Chun; Suenari, Kazuyoshi; Huang, Sheng‐Chieh; Tung, Nguyen-Huu; Higa, Satoshi; Tai, Ching‐Tai; Ueng, Kwo‐Chang; Li, Cheng-Hung; Chao, Tze‐Fan; Wu, Tsu‐Juey; Chen, Shih‐Ann

doi:10.1111/j.1540-8167.2010.01927.x

Cited by 22 publications

(21 citation statements)

References 25 publications

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“…Catheter ablation has become an effective treatment for patients with atrial fibrillation (2,3); however, recurrent atrial fibrillation still remains a current issue after pulmonary vein isolation and has been shown to be related to both electrical and structural remodeling of the atrium (4).…”

Section: Resultsmentioning

confidence: 99%

“…Given the correlation of LAV and recurrence of atrial fibrillation, accurate assessment of LAV plays a crucial role in selecting patients who are most likely to benefit from pulmonary vein isolation (5). In addition, LAV is an important marker for other cardiac disease processes, such as diastolic heart failure, where accurate assessment is important for precisely defining the extent of the disease (1,4).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Left atrial volume quantification using cardiac MRI in atrial fibrillation: comparison of the Simpson’s method with biplane area-length, ellipse, and three-dimensional methods

Nacif

Barranhas²,

Türkbey³

et al. 2012

Diagn Interv Radiol

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Left atrial volume quantification using cardiac MRI in atrial fibrillation: comparison of the Simpson’s method with biplane area-length, ellipse, and three-dimensional methods

Nacif

Barranhas²,

Türkbey³

et al. 2012

Diagn Interv Radiol

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“…A reverse electrical and structural remodeling after the ablation of persistent AF occurred only in the recurrence pattern of paroxysmal AF. 7 As the mechanism, atrial fibrosis is related to atrial structural remodeling and leads to structural and functional impairment of the LA and persistence of AF. 14,20, 21 The patients with persistent AF resistant to termination by ablation might have much atrial fibrosis in the LA as compared with those whose AF was effectively terminated by ablation.…”

Section: La Reverse Remodeling After Ablationmentioning

confidence: 99%

Pre-Procedural Prediction of Termination of Persistent Atrial Fibrillation by Catheter Ablation as an Indicator of Reverse Remodeling of the Left Atrium

Kumagai

Sakamoto

Nakamura

et al. 2013

Circ J

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“…Change to paroxysmal AF decreases total AF burden that allows for LA remodeling. [19][20][21] Lo et al 22 examined electrophysiological findings in patients with nonparoxysmal AF undergoing ablation with a stepwise approach and found that overall LA bipolar voltage increased, total area of low voltage (<0.5 mV) decreased, and total LA volume decreased in patients whose arrhythmia recurrence had been transformed to paroxysmal AF compared with those who recurred as persistent AF. Although in the current study, we did not assess and compare bipolar voltage abnormalities during the initial and repeat ablation procedures, we have previously shown that after PVI, patients who remain arrhythmia free experience favorable atrial and even ventricular remodeling.…”

Section: Implications Of Transformation From Nonparoxysmal To Paroxysmentioning

confidence: 99%

Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

Liang¹,

Elafros²,

Muser³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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A lthough pulmonary vein isolation (PVI) is well accepted to be the cornerstone of ablation for paroxysmal atrial fibrillation (AF), there remains lack of consensus on the optimal ablation strategy in patients with persistent and longstanding persistent AF. [1][2][3] Although an ablation strategy limited primarily to PVI, with or without targeting of documented nonpulmonary vein (PV) triggers, results in lower long-term AF-free survival rates in patients with persistent and longstanding persistent AF than paroxysmal AF, outcomes are not improved with more extensive substrate modification strategies.2,3 It has been shown that ≈50% of patients with persistent and long-standing persistent AF who undergo extensive substrate modification experience persistent organized atrial tachyarrhythmias (OAT) after ablation. 4,5 In contrast, patients with persistent and long-standing persistent AF treated with a more targeted ablation strategy (PVI with or without documented non-PV trigger ablation) are more likely to experience arrhythmia recurrences in the form of AF instead of OATs. However, when the arrhythmia recurrence in these patients is paroxysmal in nature, this likely suggests a favorable modification of the underlying AF substrate, which becomes less capable of sustaining AF.The objective of this study, therefore, was to determine the nature of initial arrhythmia recurrence in patients with © 2016 American Heart Association, Inc. Original ArticleBackground-Transformation from persistent to paroxysmal atrial fibrillation (AF) after ablation suggests modification of the underlying substrate. We examined the nature of initial arrhythmia recurrence in patients with nonparoxysmal AF undergoing antral pulmonary vein isolation and nonpulmonary vein trigger ablation and correlated recurrence type with long-term ablation efficacy after the last procedure. Methods and Results-Three hundred and seventeen consecutive patients with persistent (n=200) and long-standing persistent (n=117) AF undergoing first ablation were included. AF recurrence was defined as early (≤6 weeks) or late (>6 weeks after ablation) and paroxysmal (either spontaneous conversion or treated with cardioversion ≤7 days) or persistent (lasting >7 days). During median follow-up of 29.8 (interquartile range: 14.8-49.9) months, 221 patients had ≥1 recurrence. Initial recurrence was paroxysmal in 169 patients (76%) and persistent in 52 patients (24%). Patients experiencing paroxysmal (versus persistent) initial recurrence were more likely to achieve long-term freedom off antiarrhythmic drugs (hazard ratio, 2.2; 95% confidence interval, 1.5-3.2; P<0.0001), freedom on/off antiarrhythmic drugs (hazard ratio, 2.5; 95% confidence interval, 1.6-3.8; P<0.0001), and arrhythmia control (hazard ratio, 5.2; 95% confidence interval, 2.9-9.2; P<0.0001) after last ablation. Conclusions-In patients with persistent and long-standing persistent AF, limited ablation targeting pulmonary veins and documented nonpulmonary vein triggers improves the maintenance of sinus rhythm and re...

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Different Patterns of Atrial Remodeling After Catheter Ablation of Chronic Atrial Fibrillation

Abstract: A better outcome with reverse electrical and structural remodeling occurred after the ablation of chronic AF when the recurrence was paroxysmal AF. Progressive electrical remodeling without any structural remodeling developed in those with a recurrence involving persistent AF.

Cited by 22 publications

References 25 publications

Left atrial volume quantification using cardiac MRI in atrial fibrillation: comparison of the Simpson’s method with biplane area-length, ellipse, and three-dimensional methods

Left atrial volume quantification using cardiac MRI in atrial fibrillation: comparison of the Simpson’s method with biplane area-length, ellipse, and three-dimensional methods

Pre-Procedural Prediction of Termination of Persistent Atrial Fibrillation by Catheter Ablation as an Indicator of Reverse Remodeling of the Left Atrium

Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

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