Is there an anatomical substrate for idiopathic paroxysmal atrial fibrillation? A case–control echocardiographic study

Sitges, Marta; Teijeira, Victor A.; Scalise, Andrea; Vidal, Bárbara; Tamborero, David; Coll-Vinent, Blanca; Rivera, Socorro; Molina, Irma; Azqueta, Manel; Paré, Carles; Brugada, Josep; Mont, Lluı́s

doi:10.1093/europace/eum045

Cited by 33 publications

(28 citation statements)

References 24 publications

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“…AF is a progressive condition that begins with hemodynamic and/or structural changes in the LA and evolves throughout the paroxysmal and persistent stage [25]. LA enlargement has been widely related to AF, both in chronic AF and in paroxysmal AF [27,28]. In the present study, patients with silent AF showed only a trend towards LA enlargement (indexed LA volume 37.4 vs. 30.8 ml/m 3 , p = 0.057).…”

Section: Discussionmentioning

confidence: 99%

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Fernández

Béjot²,

Zeller

et al. 2014

Eur Neurol

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Background: Since atrial fibrillation (AF) may be undiagnosed when asymptomatic and paroxysmal, we aimed to investigate the incidence and determinants of silent AF in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Consecutive patients admitted to the Stroke Unit of the University Hospital of Dijon, France, for acute ischemic stroke or TIA were prospectively enrolled from March to December 2012. Silent AF was assessed by continuous electrocardiography (ECG) monitoring for 24 h after admission. An echocardiography was performed at day 2 ± 1 to measure left ventricular ejection fraction (LVEF) and left auricular (LA) dimensions. Results: Among the 187 patients included, 19 (10%) developed silent AF. Patients with silent AF were markedly older (76 vs. 66 years, p < 0.002), with lower creatinine levels (90 vs. 80 µmol/l, p = 0.030) and were less often smokers (5 vs. 24%, p = 0.058) than patients without silent AF. They also showed a trend towards more frequent hypertension and a recent history of infection. Patients with silent AF had a larger indexed LA volume (37.4 vs. 30.8 ml/m³, p = 0.057) and LA diameter (23.2 vs. 20.8 mm/m², p = 0.059). LVEF in the two groups was similar. In multivariate analysis, only age remained an independent estimate of silent AF. Conclusion: Silent AF detected by continuous ECG monitoring is common and closely associated with older age. Further studies are needed to investigate the interest of systematically screening for silent AF for secondary prevention after ischemic stroke/TIA.

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Section: Discussionmentioning

confidence: 99%

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Fernández

Béjot²,

Zeller

et al. 2014

Eur Neurol

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“…[8][9][10] Despite the contribution of LA enlargement to the occurrence and progression of AF, 10-13 the assessment of LA volume (LAV)-the most robust marker of LA sizeis not recommended for routine use in risk evaluation, because its predictive value seems lower than expected. 14,15 LA functional evaluation might improve the identification of patients at risk for AF.…”

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confidence: 99%

Incremental Value of Left Atrial Structural and Functional Characteristics for Prediction of Atrial Fibrillation in Patients Receiving Cardiac Pacing

Kosmala

Saito

Kaye

et al. 2015

Circ: Cardiovascular Imaging

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A trial fibrillation (AF) is a known complication of right ventricular (RV) pacing, 1,2 occurring in 3% to 15% per year, being more common in older subjects and in the absence of AV synchrony. 3,4 As AF poses a significant medical and economic burden, 5 appropriate risk prediction for AF might be helpful in improving the cost-effectiveness of diagnostic and therapeutic measures directed toward preventing this arrhythmia and its well-known consequences.6 However, risk factors for AF are multiple and many of them remain ill-defined, 7 so additional risk profiling to stratify the risk of pacemaker-related AF may enable a more personalized approach to decision-making.Left atrial (LA) remodeling, including changes in LA size, function, and electric properties, provides a substrate for AF. [8][9][10] Despite the contribution of LA enlargement to the occurrence and progression of AF, 10-13 the assessment of LA volume (LAV)-the most robust marker of LA sizeis not recommended for routine use in risk evaluation, because its predictive value seems lower than expected. 14,15 LA functional evaluation might improve the identification of patients at risk for AF. Recently, LA strain has been Background-Better prediction of cardiac pacing patients at risk of atrial fibrillation (AF) would enable more effective prophylaxis. We sought whether left atrial (LA) electromechanical conduction time (EMT) and myocardial mechanics were associated with incident AF in patients undergoing dual chamber pacemaker implantation, independent of left atrial volume (LAV). Methods and Results-Clinical data were obtained prospectively in 146 enrollees (73±10 years) undergoing dual chamber pacemaker implantation in the Protect-Pace study. Echocardiograms and 2-dimensional strain analysis were obtained post implantation and at 2 years. Complete ascertainment of AF during follow-up was identified from interrogation of permanent pacemakers. Cox regression was used to identify correlates of AF. Incident AF (n=29, 20%) was associated with higher systolic blood pressure (P=0.01), lower left ventricular ejection fraction (P=0.03), lower LA strain at atrial contraction (LASac; P<0.001), higher LAV (P<0.003), and longer septal electromechanical conduction time (P<0.01).The associations of LAV and LASac with incident AF were independent of age, sex, systolic blood pressure, and left ventricular size and function. However, the combination of the 3 strongest predictors showed LASac (P=0.02) and systolic blood pressure (P=0.01) were independently associated with incident AF, but LAV was not (P=0.07). Using the optimal cut points from receiver operator characteristic curves (62 mL for LAV and 8.6% for LASac), we demonstrated that a significantly greater rate of AF was associated with both lower LASac at higher LAV and with lower LASac at lower LAV. Conclusions-The risk of AF in patients receiving dual chamber pacing is independently associated with LA size and function, not left ventricular structural and functional characteristics or right ventricular lead locatio...

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“…Так, M. Sitges et al (2007 г.) выявили снижение систо-лических миокардиальных скоростей (s) фиброз-ного кольца МК у пациентов с ФП в сравнении со здоровыми добровольцами [14]. Аналогичная тенденция отмечена и в нашем исследовании.…”

Section: Discussionunclassified

Structural and functional condition of mitral and tricuspid valves in patients with various forms of atrial fibrillation

Bockeriа¹,

Bockeria²,

Mironenko³

et al. 2016

Ann aritmol

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Is there an anatomical substrate for idiopathic paroxysmal atrial fibrillation? A case–control echocardiographic study

Abstract: Patients with idiopathic AF showed larger left atria when compared with controls, there being no differences between patients with a first episode or a recurrence. This suggests the presence of an enhanced substrate to develop idiopathic lone AF.

Cited by 33 publications

References 24 publications

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

Incremental Value of Left Atrial Structural and Functional Characteristics for Prediction of Atrial Fibrillation in Patients Receiving Cardiac Pacing

Structural and functional condition of mitral and tricuspid valves in patients with various forms of atrial fibrillation

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