Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation

Montserrat, Sílvia; Gabrielli, Luigi; Bijnens, Bart; Borràs, Roger; Berruezo, Antonio; Poyatos, Silvia; Brugada, Josep; Mont, Lluís; Sitges, Marta

doi:10.1016/j.hrthm.2014.08.032

Cited by 68 publications

(48 citation statements)

References 29 publications

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“…Combination with other CMR indices such as atrial T1 mapping, LV scar, ventricular postcontrast T1‐mapping, and PV size may also improve overall performance, but were not investigated in this study. However, a multimodality score is most likely to achieve the highest precision, and other noninvasive non‐CMR indices including surface ECG dominant frequency and LA deformation patterns on echocardiography may be combined with invasive characterization such as voltage mapping to optimize ablation strategies through the identification of a high‐performance biomarker.…”

Section: Discussionmentioning

confidence: 99%

A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

Chubb

Karim

Mukherjee

et al. 2019

Cardiovasc electrophysiol

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Introduction Multiple cardiac magnetic resonance (CMR)‐derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long‐term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), left ventricular ejection fraction (LVEF), LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long‐term single‐center study. Methods and Results Eighty‐nine patients (53% paroxysmal AF, 73% male) underwent comprehensive CMR study before first‐time AF ablation (median follow‐up 726 days [IQR: 418‐1010 days]). The 3D late gadolinium‐enhanced acquisition (1.5T, 1.3 × 1.3 × 2 mm) was quantified for fibrosis; LA volume and sphericity were assessed on manual segmentation at atrial diastole; LAEF and LVEF were quantified on multislice cine imaging. AF recurred in 43 patients (48%) overall (31 at 1 year). In the recurrence group, LA fibrosis was higher (42% vs 29%; hazard ratio [HR]: 1.032; P = .002), left atrial ejection fraction (LAEF) lower (25% vs 34%; HR: 0.063; P = .016) and LVEF lower (57% vs 63%; HR: 0.011; P = .008). LA volume (135 vs 124 mL) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (Model 1), additionally AF type (Model 2) and combined (Model 3). In Models 1 and 2, LA fibrosis, LAEF, and LVEF were independently associated with outcome, but only LA fibrosis was independent in Model 3 (HR: 1.021; P = .022). Conclusions LAEF, LVEF, and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome.

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Section: Discussionmentioning

confidence: 99%

A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

Chubb

Karim

Mukherjee

et al. 2019

Cardiovasc electrophysiol

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“…In AF patients, AF recurrence is closely associated with baseline LA function (28, 29). In routine practice, LA volume is frequently used to predict LA dysfunction and remodeling, however, LA deformation indices are more sensitive and their impairment can be detected before dilatation occurs.…”

Section: Discussionmentioning

confidence: 99%

Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation

İpek¹,

Marine²,

Habibi³

et al. 2016

Heart Rhythm

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Background Symptomatic left atrial (LA) flutter (LAFL) is common following atrial fibrillation (AF) ablation. Objective To examine the association of baseline LA function with incident LAFL following AF ablation. Methods The source cohort included 216 patients with cardiac magnetic resonance (CMR) prior to initial AF ablation between 2010 and 2013. Patients who underwent cryoballoon or laser ablation, patients with AF during CMR, and those with suboptimal CMR, or missing follow-up data were excluded. Baseline LA volume and function were assessed by feature-tracking CMR analysis. Results The final cohort included 119 patients (age 58.9±11 years, 76.5% male, 70.6% paroxysmal AF). During a median follow-up of 421 (interquartile range 235–751) days, 22 (18.5%) patients developed LAFL. Baseline LA volume was similar between the two groups. In contrast, baseline reservoir, conduit and contractile function of the LA were significantly impaired in patients with incident LAFL. Baseline global peak longitudinal atrial strain (PLAS) < 22.65% predicted incident LAFL with 86% sensitivity and 68% specificity (C-statistic 0.76). In a multivariable model adjusting for age, heart failure, and LA volume, PLAS (HR 0.9 per % increase in PLAS, p=0.003) and LA linear lesions (HR 2.94, p=0.020) were independently associated with incident LAFL. Coexistence of PLAS<22.65% and linear lesions was associated with 9-fold increased hazard of incident LAFL. Conclusion Baseline LA function and linear lesions were independently associated with incident LAFL after AF ablation. Linear lesions should be limited to selected cases, especially in patients with impaired LA function.

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“…21 The LA reservoir function evaluated by bi-dimensional echocardiographic speckle tracking was associated with the onset of symptoms among patients with heart failure with preserved ejection fraction 22 and showed to be an important predictor of CV diseases occurrence and survival among patients with heart failure and decreased ejection fraction. 21 The LA reservoir function evaluated by bi-dimensional echocardiographic speckle tracking was associated with the onset of symptoms among patients with heart failure with preserved ejection fraction 22 and showed to be an important predictor of CV diseases occurrence and survival among patients with heart failure and decreased ejection fraction.…”

Section: La Function and Cardiovascular Eventsmentioning

confidence: 96%

Early left atrial dysfunction is associated with suboptimal cardiovascular health

et al. 2019

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Aims: Two-dimensional speckle-tracking echocardiography can assess left atrial (LA) function by measuring atrial volumes and deformation parameters (strain, strain rate). This cross-sectional analysis explores the association between ideal CV health (CVH), LA function, and systemic biomarkers in healthy individuals from the Chilean MAUCO Cohort. Methods:We enrolled 95 MAUCO participants with different levels of CVH (mean age: 51 ± 8 years). We categorized participants into low or high CVH groups: A: 0-2, or B: 3-6 CVH risk factors. 2D echocardiography, glucose, insulin, total cholesterol, triglycerides, proBNP, hsCRP, insulin resistance index (HOMA), and right and left atrial strain (RASs and LASs, respectively) were determined.Results: LASs was lower in Group A, while systolic and diastolic blood pressure (BP), body mass index (BMI), insulin, HOMA, total cholesterol, triglycerides, and LV and RV end-diastolic volume were significantly higher in Group A than Group B (P < .01).Change in LASs was inversely correlated with insulin (P = .040), HOMA (P = .013), total cholesterol (P = .039), glycemia (P = .018), and BMI (P = .0.037). Conclusion:LASs during the reservoir phase was diminished in subjects with a lower level of CVH. Higher insulin, HOMA, total cholesterol, glycemia, and BMI

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Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation

Cited by 68 publications

References 29 publications

A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation

Early left atrial dysfunction is associated with suboptimal cardiovascular health

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