Left atrial size and total atrial emptying fraction in atrial fibrillation progression

Seewöster, Timm; Spampinato, Ricardo; Sommer, Philipp; Lindemann, Frank; Jahnke, Cosima; Paetsch, Ingo; Hindricks, Gerhard; Kornej, Jelena

doi:10.1016/j.hrthm.2019.06.014

Cited by 23 publications

(22 citation statements)

References 24 publications

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“…An IAAT ≥143 ms as marker for electrical conduction slowing and a LA-EF ≤33 and LASct ≤6.8% as markers for mechanical dysfunction were significant predictors of arrhythmia recurrence after PVI. In line with previous studies, the current study shows that the non-invasive parameters LA-EF, LAS, and aPWD might enable an early diagnosis of ACM and thus allow a timely identification and treatment of patients at risk for new-onset AF (Jadidi et al, 2018;Pilichowska-Paszkiet et al, 2018;Seewoster et al, 2019;Muller-Edenborn et al, 2020). The current findings might also serve as an explanation for the fact that reduced LASr and prolonged aPWD were reliable markers to predict new-onset AF in patients with heart failure with preserved ejection fraction (HFpEF) (Muller-Edenborn et al, 2020;Park et al, 2020) or could be detected more frequently in patients with persistent AF than in those with paroxysmal AF or those without history of AF (Reddy et al, 2020).…”

Section: Atrial Cardiomyopathy Atrial Fibrillation and Heart Failuresupporting

confidence: 89%

“…compliance and contractility (Pilichowska-Paszkiet et al, 2018;Seewoster et al, 2019). However, from the previously available data it remains unclear whether these effects occur in parallel or individually.…”

Section: Left Atrial Function In Atrial Cardiomyopathymentioning

confidence: 99%

“…The development of ACM itself, and the consequences to AF-persistency, were investigated in a variety of clinical studies. ACM was found to impair left atrial function on several levels: First, ACM was associated with impaired left atrial mechanical function as evidenced by standard 2Dechocardiography and speckle tracking (Pilichowska-Paszkiet et al, 2018;Seewoster et al, 2019). Second, ACM affects the electrical function of the left atrium, as is evidenced by progressive intra-atrial conduction slowing in these patients (Jadidi et al, 2018;Muller-Edenborn et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

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Left Atrial Hypertension, Electrical Conduction Slowing, and Mechanical Dysfunction – The Pathophysiological Triad in Atrial Fibrillation-Associated Atrial Cardiomyopathy

et al. 2021

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BackgroundAtrial fibrillation (AF) is the most common arrhythmia and a significant burden for healthcare systems worldwide. Presence of relevant atrial cardiomyopathy (ACM) is related to persistent AF and increased arrhythmia recurrence rates after pulmonary vein isolation (PVI).ObjectiveTo investigate the association of left atrial pressure (LAP), left atrial electrical [invasive atrial activation time (IAAT) and amplified p-wave duration (aPWD)] and mechanical [left atrial emptying fraction (LA-EF) and left atrial strain (LAS)] functional parameters with the extent of ACM and their impact on arrhythmia recurrence following PVI.Materials and MethodsFifty patients [age 67 (IQR: 61–75) years, 78% male] undergoing their first PVI for persistent AF were prospectively included. LAP (maximum amplitude of the v-wave), digital 12-lead electrocardiogram, echocardiography and high-density endocardial contact mapping were acquired in sinus rhythm prior to PVI. Arrhythmia recurrence was assessed using 72-hour Holter electrocardiogram at 6 and 12 months post PVI.ResultsRelevant ACM (defined as left atrial low-voltage extent ≥2 cm2 at <0.5 mV threshold) was diagnosed in 25/50 (50%) patients. Compared to patients without ACM, patients with ACM had higher LAP [17.6 (10.6–19.5) mmHg with ACM versus 11.3 (7.9–14.0) mmHg without ACM (p = 0.009)]. The corresponding values for the electrical parameters were 166 (149–181) ms versus 139 (131–143) ms for IAAT (p < 0.0001), 163 (154–176) ms versus 148 (136–152) ms for aPWD on surface-ECG (p < 0.0001) and for the mechanical parameters 27.0 (17.5–37.0) % versus 41.0 (35.0–45.0) % for LA-EF in standard 2D-echocardiography (p < 0.0001) and 15.2 (11.0–21.2) % versus 29.4 (24.9–36.6) % for LAS during reservoir phase (p < 0.0001). Furthermore, all parameters showed a linear correlation with ACM extent (p < 0.05 for all). Receiver-operator-curve-analysis demonstrated a LAP ≥12.4 mmHg [area under the curve (AUC): 0.717, sensitivity: 72%, and specificity: 60%], a prolonged IAAT ≥143 ms (AUC: 0.899, sensitivity: 84%, and specificity: 80%), a prolonged aPWD ≥153 ms (AUC: 0.860, sensitivity: 80%, and specificity: 79%), an impaired LA-EF ≤33% (AUC: 0.869, sensitivity: 84%, and specificity: 72%), and an impaired LAS during reservoir phase ≤23% (AUC: 0.884, sensitivity: 84%, and specificity: 84%) as predictors for relevant ACM. Arrhythmia recurrence within 12 months post PVI was significantly increased in patients with relevant ACM ≥2 cm2, electrical dysfunction with prolonged IAAT ≥143 ms and mechanical dysfunction with impaired LA-EF ≤33% (66 versus 20, 50 versus 23 and 55 versus 25%, all p < 0.05).ConclusionLeft atrial hypertension, electrical conduction slowing and mechanical dysfunction are associated with ACM. These findings improve the understanding of ACM pathophysiology and may be suitable for risk stratification for new-onset AF, arrhythmia recurrence following PVI, and development of novel therapeutic strategies to prevent AF and its associated complications.

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Section: Atrial Cardiomyopathy Atrial Fibrillation and Heart Failuresupporting

confidence: 89%

Section: Left Atrial Function In Atrial Cardiomyopathymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left Atrial Hypertension, Electrical Conduction Slowing, and Mechanical Dysfunction – The Pathophysiological Triad in Atrial Fibrillation-Associated Atrial Cardiomyopathy

et al. 2021

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“…Although there was a significant association between NT-proANP and different LA size parameters, such as LA volume, anterior-posterior, superior-inferior and transversal diameter, the LA volume remained most significantly associated with biomarkers [1]. In another study, however, the association between advanced AF progression and LA-EF was stronger than with LA size only [2] .…”

mentioning

confidence: 76%

Left atrial function and NT-proANP as markers of AF progression and impaired outcome in patients with heart failure with preserved ejection fraction

Seewöster

Kornej

2019

Int J Cardiovasc Imaging

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“…The LA size is another important parameter of AF progression. The role of the LA volume (LAV) and LA function as surrogate parameters for higher AF burden 4 and LVAs presence 5,6 are well described. In addition, there is an association between atrial flutter-a right atrial (RA), and AFa left atrial disease.…”

mentioning

confidence: 99%

Biatrial volume ratio predicts low voltage areas in atrial fibrillation

Seewöster

Dinov

Nedios

et al. 2021

Clinical Cardiology

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Background: Left atrial volume (LAV) and low voltage areas (LVAs) are acknowledged markers for worse rhythm outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients.Objective: To investigate association between the LAV/RAV ratio and LVAs presence.Methods: Patients undergoing first AF ablation were included. LVAs were assessed periprocedurally using high-density 3D maps and defined as <0.5 mV. All patients underwent pre-procedural cardiovascular magnetic resonance imaging. LAV (biplane) and RAV (monoplane 4-chamber) were assessed prior to ablation, and the LAV/RAV ratio was calculated. Results:The study population included 189 patients (age mean 63 ± 10 years, 33% women, 57% persistent AF, 22% LVAs). There were 149 (79%) patients with LAV > RAV. In univariable analysis LAV > RAV was associated with LVAs (OR 6.803, 95%CI 1.395-26.514, p = .016). The association remained robust in multivariable model after adjustment for persistent AF, CHA 2 DS 2 -VASc score, and heart rate (OR 5.981,, p = .025). Using receiver operator curve analysis, LAV > RAV (AUC 0.668, 95%CI 0.585-0.751, p = .001) was significant predictor for LVAs. In multivariable analysis, after adjustment for age, persistent AF, and renal function, RAV≥LAV was threefold higher in males (OR 3.040, 95%CI 1.050-8.802, p = .04).Conclusions: LAV > RAV is useful for the prediction of electro-anatomical substrate in AF. LAV > RAV was associated with LVAs presence, while male sex remained associated with RAV≥LAV and less LVAs.

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Left atrial size and total atrial emptying fraction in atrial fibrillation progression

Cited by 23 publications

References 24 publications

Left Atrial Hypertension, Electrical Conduction Slowing, and Mechanical Dysfunction – The Pathophysiological Triad in Atrial Fibrillation-Associated Atrial Cardiomyopathy

Left Atrial Hypertension, Electrical Conduction Slowing, and Mechanical Dysfunction – The Pathophysiological Triad in Atrial Fibrillation-Associated Atrial Cardiomyopathy

Left atrial function and NT-proANP as markers of AF progression and impaired outcome in patients with heart failure with preserved ejection fraction

Biatrial volume ratio predicts low voltage areas in atrial fibrillation

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