Mechanical and substrate abnormalities of the left atrium assessed by 3-dimensional speckle-tracking echocardiography and electroanatomic mapping system in patients with paroxysmal atrial fibrillation

Watanabe, Yoshikazu; Nakano, Yukiko; Hidaka, Takayuki; Oda, Noboru; Kajihara, Kenta; Tokuyama, Takehito; Uchimura, Yuko; Sairaku, Akinori; Motoda, Chikaaki; Fujiwara, Mai; Kawazoe, Hiroshi; Matsumura, Hiroya; Kihara, Yasuki

doi:10.1016/j.hrthm.2014.12.007

Cited by 45 publications

(37 citation statements)

References 30 publications

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“…In a study by Rolf et al., LVZs were found in 9.7% of patients, with the most affected areas being anterior, septal, and posterior walls and roof. In this study, LVZs were found in 36.1% of patients with PAF, which is in accord with the observation by Watanabe et al., who identified LVZs in 23 PAF patients (44.2%). Furthermore, we found the most frequently affected zones were roof and anterior and lateral walls.…”

Section: Discussionsupporting

confidence: 93%

“…Although focal triggering was believed to be the predominant mechanism for PAF, substrate remodeling, surrogated by LVZs, was also demonstrated to be present in many patients and associated with poor ablation outcome . Limited studies have characterized the prevalence and spatial distribution of LVZs in PAF, with high variability . With computed tomography scanning and EAM, Hori et al.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Alcohol Consumption on Substrate Remodeling and Ablation Outcome of Paroxysmal Atrial Fibrillation

Shi

Hou

et al. 2015

JAHA

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BackgroundThe effect of alcohol consumption on substrate remodeling and ablation outcome of paroxysmal atrial fibrillation (PAF) remains unknown.Methods and ResultsWe performed circumferential pulmonary vein isolation (CPVI) and voltage mapping of left atrium (LA) during sinus rhythm in 122 consecutive patients with symptomatic PAF (age, 55.4±9.4 years; 73.8% men). Low‐voltage zones (LVZs) were semiquantitatively estimated and presented as low‐voltage index (LVI). Each patient's daily alcohol consumption history was recorded at baseline and classified into alcohol abstainers, moderate drinkers, and heavy drinkers based on the National Institute on Alcohol Abuse and Alcoholism definition. Follow‐up was ≥12 months for AF recurrence. Alcohol abstainers and moderate and heavy drinkers were 70 (57.4%), 13 (10.6%), and 39 (32.0%), respectively. In total, LVZs were observed in 44 patients (36.1%). Daily alcohol consumption independently predicted presence of LVZs (odds ratio [OR], 1.097; 95% confidence interval [CI], 1.001–1.203; P=0.047). During mean follow‐up of 20.9±5.9 months, 40 patients (35.1%) experienced AF recurrence. Success rate was 81.3%, 69.2%, and 35.1% in alcohol abstainers, moderate drinkers, and heavy drinkers, respectively (overall log rank, P<0.001). Multivariate analysis showed that both alcohol consumption and LVI were independent predictors of AF recurrence (hazard ratio [HR], 1.579; 95% CI, 1.085–2.298; P=0.017; HR, 2.188; 95% CI, 1.582–3.026; P<0.001, respectively). Furthermore, mediation analysis revealed that LVZs acted as a partial mediator in effect of alcohol consumption on AF ablation outcomes.ConclusionsDaily alcohol consumption was associated with atrial remodelling, and heavy drinkers have substantial risk for AF recurrence after CPVI.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Impact of Alcohol Consumption on Substrate Remodeling and Ablation Outcome of Paroxysmal Atrial Fibrillation

Shi

Hou

et al. 2015

JAHA

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“…Preprocedural TEE is used to exclude the presence of left atrial thrombus prior to CA. Preprocedure CT or MRI imaging tests are performed for evaluation of left atrial and pulmonary venous anatomy, and for image integration with nonfluoroscopic 3‐D mapping . Postprocedural TEE is generally used when required to exclude thrombus prior to cardioversion or repeat CA for recurrent AF.…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation for the treatment of atrial fibrillation is associated with a reduction in health care resource utilization

Samuel

Tsadok

Joza

et al. 2017

Cardiovasc electrophysiol

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“…Fibrosis likely serves as a substrate for slow conduction and creates anatomical obstacles that enable the development of a critical isthmus. In a previous study, a significant association was found between lower PLAS and the presence of low voltage regions (18). Similarly, LA contractile function is associated with the extent of low voltage (< 0.5 mV) (19).…”

Section: Discussionmentioning

confidence: 82%

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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Mechanical and substrate abnormalities of the left atrium assessed by 3-dimensional speckle-tracking echocardiography and electroanatomic mapping system in patients with paroxysmal atrial fibrillation

Cited by 45 publications

References 30 publications

Impact of Alcohol Consumption on Substrate Remodeling and Ablation Outcome of Paroxysmal Atrial Fibrillation

Impact of Alcohol Consumption on Substrate Remodeling and Ablation Outcome of Paroxysmal Atrial Fibrillation

Catheter ablation for the treatment of atrial fibrillation is associated with a reduction in health care resource utilization

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

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