Left Atrial Asynchrony Measured by Pulsed-Wave Tissue Doppler Is Associated With Abnormal Atrial Voltage and Recurrences of Atrial Fibrillation After Catheter Ablation

Löbe, Susanne; Knopp, Helge; Le, Thuy-Vi; Nedios, Sotirios; Seewöster, Timm; Bode, Kerstin; Sommer, Philipp; Bollmann, Andreas; Hindricks, Gerhard; Dinov, Borislav

doi:10.1016/j.jacep.2018.08.017

Cited by 7 publications

(5 citation statements)

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“…Our results complement previous studies and imply that LVDD can result in asymmetric LA dilatation and a specific delayed anterior activation. These characteristics specify advanced AF that might necessitate changes in management to address the developing substrate, for example, radiofrequency ablation instead of cryoablation 9,10 …”

Section: Discussionmentioning

confidence: 99%

“…Despite the similar use of antiarrhythmic drugs in the groups, the study was not powered enough to address the effect of drugs on atrial electrophysiology or the effects of the U‐pattern and ASI on AF recurrences. Although we previously demonstrated the association of the U‐pattern with low‐voltage areas, 9 the current study was not aiming and was powered to assess the interaction between ASI, LA scar and activation. Our group is working on an automated shape analysis in a larger cohort, but ASI in this study was calculated manually, with good inter and intraobserver agreement, limiting the size of the study.…”

Section: Limitationsmentioning

confidence: 94%

“…In contrast, we examined LA activation at four sites and found that LA activation indexes were significantly associated with abnormal LA voltage and recurrences after CA. The U‐pattern was more common in those with LA scar than those with normal LA voltage (100% vs. 84%, p = .015) 9 . Thus, we hypothesized that conduction disturbances in the Bachmann bundle (BB) or asymmetrical anatomical LA remodeling may explain these findings.…”

Section: Introductionmentioning

confidence: 97%

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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: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 97%

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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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“…[118][119][120] Myocardial tissue velocities of the LA have been shown to predict new-onset AF and AF recurrences following cardioversion and ablation. [121][122][123][124] In addition, TDI has been validated to calculate total atrial conduction time (TACT), which is related to the incidence of new-onset AF in post-SA patients and recurrence in patients known to have persistent AF. 123,124 TACT is defined as the duration from the onset of the P wave to the peak atrial contraction velocity at the lateral left atrial wall.…”

Section: Introductionmentioning

confidence: 99%

“…125,126 Atrial asynchrony, assessed by comparing regional differences in TACT, has been shown to be associated with low atrial voltages during CA and higher rates of AF recurrence. 122 A major limitation of TDI is that it is angle dependent, such that the sample tissue has to be parallel to the probe for accurate measurement of tissue velocities and strain assessment. 127 Two-dimensional speckle-tracking echocardiography has overcome these limitations by being independent of the direction of movement, and is not affected by volume changes and preload conditions.…”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic surgical ablation versus catheter ablation as first-line treatment for long-standing persistent atrial fibrillation: the CASA-AF RCT

et al. 2021

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Background Standalone thoracoscopic surgical ablation may be more effective than catheter ablation in patients with long-standing persistent atrial fibrillation. Objectives To determine whether or not surgical ablation is clinically superior to catheter ablation as the first-line treatment strategy in long-standing persistent atrial fibrillation. Design This was a prospective, multicentre, randomised control trial. Setting Four NHS tertiary centres in England. Participants Adults with long-standing persistent atrial fibrillation, who had European Heart Rhythm Association symptom scores > 2 and who were naive to previous catheter ablation or thoracic/cardiac surgery. Interventions Minimally invasive thoracoscopic surgical ablation and conventional catheter ablation (control intervention). Main outcome measures The primary outcome was freedom from atrial fibrillation/tachycardia ≥ 30 seconds after a single procedure without antiarrhythmic drugs (class 1C/3) at 1 year, excluding a 3-month blanking period. The secondary outcomes include the intervention-related major complication rate; clinical success (≥ 75% reduction in arrhythmia burden); and changes in symptoms, quality of life and cost-effectiveness. Methods Patients (n = 120) were randomised to surgical ablation (n = 60) or catheter ablation (n = 60). An implanted loop recorder provided continuous cardiac monitoring following ablation. Follow-up visits were at 3, 6, 9 and 12 months. Loop recorder data were reviewed monthly by a physiologist who was blinded to the randomisation outcome. Results The study treatment was received by 55 patients in the surgical ablation arm and 60 patients in the catheter ablation arm; five patients withdrew from surgical ablation before treatment. Data from randomised and treated patients were analysed as per intention to treat. Patients had a mean age of 62.3 (standard deviation 9.6) years, were predominantly male (74%), had a mean left atrial diameter of 44.6 mm (standard deviation 6 mm) and were in continuous atrial fibrillation for 22 months (range 16–31 months). At 12 months, 26% of patients in the surgical ablation arm (14/54) and 28% of patients in the catheter ablation arm (17/60) were free from atrial arrhythmias after a single procedure without antiarrhythmic drugs (odds ratio 1.13, 95% confidence interval 0.46 to 2.83; p = 0.84). An arrhythmia burden reduction of ≥ 75% was seen in 36 out of 54 (67%) patients in the surgical ablation arm, compared with 46 out of 60 (77%) patients in the catheter ablation arm (odds ratio 1.64, 95% confidence interval 0.67 to 4.08; p = 0.3). Procedure-related serious complications within 30 days of the intervention occurred in 15% (8/55) of patients in the surgical ablation arm (including one death) compared with 10% (6/60) of patients in the catheter ablation arm (p = 0.46). Surgical ablation was associated with significantly higher costs (£23,221 vs. £18,186; p = 0.02) and fewer quality-adjusted life-years than catheter ablation (0.76 vs. 0.83; p = 0.02). Limitations This study was conducted in four highly specialised cardiology centres that have substantial experience in both treatment modalities; therefore, the results may not be widely generalisable. The study was not powered to detect small differences in efficacy. Conclusions We found no evidence to suggest that standalone thoracoscopic surgical ablation outcomes were superior to catheter ablation outcomes in achieving freedom from atrial arrhythmia after a single procedure without antiarrhythmic drugs. Moreover, surgical ablation is associated with a longer hospital stay, smaller improvements in quality of life and higher health-care costs than catheter ablation (standard care therapy). Future work Evaluation of the impact of ablation treatments on sinus rhythm maintenance and quality of life with extended follow-up to 3 years. Model-based economic analysis to estimate long-term benefits, harms and costs of surgical and catheter ablation compared with antiarrhythmic drug therapy in long-standing persistent atrial fibrillation patients. Trial registration Current Controlled Trials ISRCTN18250790 and ClinicalTrials.gov NCT02755688. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This study was supported by the UK Clinical Research Collaboration-registered King’s Clinical Trials Unit at King’s Health Partners, which is part funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London and the NIHR Evaluation, Trials and Studies Coordinating Centre. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 18. See the NIHR Journals Library website for further project information.

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Atrial remodeling and atrial fibrillation recurrence after catheter ablation

Nedios

Lindemann

Heijman

et al. 2021

Herz

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Left Atrial Asynchrony Measured by Pulsed-Wave Tissue Doppler Is Associated With Abnormal Atrial Voltage and Recurrences of Atrial Fibrillation After Catheter Ablation

Cited by 7 publications

References 2 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

Thoracoscopic surgical ablation versus catheter ablation as first-line treatment for long-standing persistent atrial fibrillation: the CASA-AF RCT

Atrial remodeling and atrial fibrillation recurrence after catheter ablation

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