Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2‐year follow‐up

An, Kang; Zhu, Jiaquan; Ma, Nan; Tang, Min; Mei, Ju

doi:10.1002/clc.22878

Cited by 5 publications

(3 citation statements)

References 30 publications

(37 reference statements)

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“…Left atrium (LA) diameter, a simple echocardiographic parameter, predicts AF recurrence risk after electrical cardioversion and is the first reported index of structural remodeling and a widely accepted predictive marker for AF [ 27 ]. On the other hand, noninvasive electrocardiography P wave indexes, such as the P wave duration, PR interval, and terminal force of P waves, have been reported as indicators of atrial electrical dysfunction [ 28 – 30 ].…”

Section: Introductionmentioning

confidence: 99%

The role of postprandial very-low-density lipoprotein in the development of atrial remodeling in metabolic syndrome

et al. 2020

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Background Negatively charged very-low-density lipoprotein (VLDL-χ) in metabolic syndrome (MetS) patients exerts cytotoxic effects on endothelial cells and atrial myocytes. Atrial cardiomyopathy, manifested by atrial remodeling with a dilated diameter, contributes to atrial fibrillation pathogenesis and predicts atrial fibrillation development. The correlation of VLDL-χ with atrial remodeling is unknown. This study investigated the association between VLDL-χ and remodeling of left atrium. Methods Consecutively, 87 MetS and 80 non-MetS individuals between 23 and 74 years old (50.6% men) without overt cardiovascular diseases were included in the prospective cohort study. Blood samples were collected while fasting and postprandially (at 0.5, 1, 2, and 4 h after a unified meal). VLDL was isolated by ultracentrifugation; the percentile concentration of VLDL-χ (%) was determined by ultra-performance liquid chromatography. The correlations of left atrium diameter (LAD) with variables including VLDL-χ, LDL-C, HDL-C, triglycerides, glucose, and blood pressure, were analyzed by multiple linear regression models. A hierarchical linear model was conducted to test the independencies of each variable’s correlation with LAD. Results The mean LAD was 3.4 ± 0.5 cm in non-MetS subjects and 3.9 ± 0.5 cm in MetS patients (P < 0.01). None of the fasting lipid profiles were associated with LAD. VLDL-χ, BMI, waist circumference, hip circumference, and blood pressure were positively correlated with LAD (all P < 0.05) after adjustment for age and sex. Significant interactions between VLDL-χ and blood pressure, waist circumference, and hip circumference were observed. When adjusted for obesity- and blood pressure-related variables, 2-h postprandial VLDL-χ (mean 1.30 ± 0.61%) showed a positive correlation with LAD in MetS patients. Each 1% VLDL-χ increase was estimated to increase LAD by 0.23 cm. Conclusions Postprandial VLDL-χ is associated with atrial remodeling particularly in the MetS group. VLDL-χ is a novel biomarker and may be a therapeutic target for atrial cardiomyopathy in MetS patients. Trial registration ISRCTN 69295295. Retrospectively registered 9 June 2020.

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Section: Introductionmentioning

confidence: 99%

The role of postprandial very-low-density lipoprotein in the development of atrial remodeling in metabolic syndrome

et al. 2020

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“…Chin et al 29 have reported that the LAEF and LAAEF have significantly decreased in patients with AF recurrence after one year, indicating that AF recurrence may worsen left atrial function. After studying the risk-predicting factors for AF recurrence following revised endoscopic ablation at two years of follow-up, An et al 30 found that the duration of AF, the diameter of left atrium, and LAAEF could significantly independently predict AF recurrence. Decreased LAEF and LAAEF in patients with AF recurrence indicate decreased function in the reservoir and contraction of the left atrium and LAA, which may denote enlarged volume of the left atrium and LAA, and consequently the anatomical parameters of the LAA also increase including the perimeter, major and minor axes of LAA orifice and LAA depth.…”

Section: Discussionmentioning

confidence: 99%

Morphological and functional parameters of left atrial appendage play a greater role in atrial fibrillation relapse after radiofrequency ablation

Tian

Zhang

Yuan

et al. 2020

Sci Rep

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this study was to quantitatively investigate the role of morphological and functional parameters of the left atrium (LA) and left atrial appendage (LAA) with 256-slice spiral computed tomography (CT) in the recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA). Eighty-three patients with AF who underwent RFA for the first time were divided into the recurrence (n = 27) and non-recurrence (n = 56) groups. All patients underwent a 256-slice spiral CT examination before the operation. The clinical data and quantitative measurement of the morphology and functional parameters of the LA and LAA were analyzed, including the maximal and minimal volume, ejection fraction and volume, and volume strain of LAA and LA (LAAVmax, LAAVmin, LAAEF, LAAEV, and LAA-VS, LAVmax, LAVmin, LAEF, LAEV and LA-VS, respectively). The CHA2DS2-VASc score and the proportion of patients with heart failure were significantly (P < 0.05) higher in the recurrence than non-recurrence group. The LAAVmax, LAAVmin, LAVmax, LAVmin, LAAV and LAV were all significantly greater in the recurrence than non-recurrence group (P < 0.05), and the perimeter, major and minor axes of LAA orifice and LAA depth were also significantly greater in the recurrence than non-recurrence group. The LAAEF, LAEF and LAA-VS were significantly (P < 0.05) lower in the recurrence than non-recurrence group (P < 0.05). Heart failure, CHA2DS2-VASC score, LAEF, LAV, LAAEF and LAA-VS were univariately significant (p < 0.05) risk factors for AF recurrence after ablation. Multivariate analysis revealed LAAEF (HR: 0.790, 95% CI: 0.657-0.950, P = 0.012) and LAAV (HR: 1.160, 95% CI: 1.095-1.229, P <0.001) to be two significant independent predictors of recurrence. ROC curve analysis showed that LAAEF <44.68% had the highest predictive value for recurrence after radiofrequency ablation, with the sensitivity of 90% and specificity of 67.4%, whereas LAA volume >9.25 ml had the highest predictive value for AF recurrence after RFA, with the sensitivity of 85.2% and specificity of 67.9%. In conclusion, the volume of left atrium, volume and morphology of left atrial appendage have all significantly increased while the ejection fraction and volume strain of left atrium and left atrial appendage have both significantly decreased in recurrence than in non-recurrence after radiofrequency ablation. The ejection fraction and volume of left atrial appendage are significant independent predictors of atrial fibrillation recurrence after radiofrequency ablation. Atrial fibrillation (AF) is the most common cardiac arrhythmia and affects 1%-2% of the general population, with the incidence increased with age 1. AF causes abnormal left atrial hemodynamics, subsequent thrombosis, myocardial infarction and heart failure, resulting in increased risks of stroke and mortality. Radiofrequency ablation aiming for pulmonary vein isolation has become an established option for drug-refractory AF, but with high rates of recurrence following ablation (accounting for 10%-30%) 2 , with the success rate of ...

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“…Left atrial (LA) diameter, a simple echocardiographic parameter, predicts AF recurrence risk after electrical cardioversion and is the rst reported index of structural remodeling and a widely accepted predictive marker for AF [27]. On the other hand, noninvasive electrocardiography P wave indexes, such as the P wave duration, PR interval, and terminal force of P waves, have been reported as indicators of atrial electrical dysfunction [28][29][30].…”

Section: Introductionmentioning

confidence: 99%

The Role of Postprandial Very-low-density Lipoprotein in the Development of Atrial Remodeling in Metabolic Syndrome

Lee

Shin

Huang

et al. 2020

Preprint

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Background:Negatively charged very-low-density lipoprotein (VLDL-χ) in metabolic syndrome (MetS) patients exerts cytotoxic effects on endothelial cells and atrial myocytes. Atrial cardiomyopathy, manifested by atrial remodeling with a dilated diameter, contributes to atrial fibrillation pathogenesis and predicts atrial fibrillation development. The correlation of VLDL-χ with atrial remodeling is unknown. This study investigated the association between VLDL-χ and left atrial dilatation. Methods: We evaluated 87 MetS and 80 non-MetS individuals between 23 and 74 years old (50.6% men) without overt cardiovascular diseases. Blood samples were collected while fasting and postprandially (at 0.5, 1, 2, and 4 hours after a unified meal). VLDL was isolated by ultracentrifugation; the percentile concentration of VLDL-χ (%) was determined by ultra-performance liquid chromatography. The correlations of left atrial diameter (LAD) with variables including VLDL-χ, LDL-C, HDL-C, triglycerides, glucose, and blood pressure, were analyzed by multiple linear regression models. A hierarchical linear model was conducted to test the independencies of each variable’s correlation with LAD. Results: The mean LAD was 3.4 ± 0.5 cm in non-MetS subjects and 3.9 ± 0.5 cm in MetS patients (P< 0.01). None of the fasting lipid profiles were associated with LAD. VLDL-χ, BMI, waist circumference, hip circumference, and blood pressure were positively correlated with LAD (all P<0.05) after adjustment for age and sex. We observedsignificant interactions between VLDL-χ and blood pressure, waist circumference, and hip circumference. When adjusted for obesity- and blood pressure-related variables, 2-hour postprandial VLDL-χ (mean 1.30 ± 0.61%) showed a positive correlation with LAD in MetS patients. Each 1% VLDL-χ increase was estimated to increase LAD by 0.62 cm. Conclusions: Postprandial VLDL-χ is associated with atrial remodeling. VLDL-χ is a novel biomarker for atrial cardiomyopathy in MetS patients and may be a therapeutic target. Trial registration: ISRCTN 69295295. Retrospectively registered 9 June 2020.

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Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2‐year follow‐up

Cited by 5 publications

References 30 publications

The role of postprandial very-low-density lipoprotein in the development of atrial remodeling in metabolic syndrome

The role of postprandial very-low-density lipoprotein in the development of atrial remodeling in metabolic syndrome

Morphological and functional parameters of left atrial appendage play a greater role in atrial fibrillation relapse after radiofrequency ablation

The Role of Postprandial Very-low-density Lipoprotein in the Development of Atrial Remodeling in Metabolic Syndrome

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