Resting and Exercise-Induced Left Atrial Hypertension in Patients With Atrial Fibrillation

Šramko, Marek; Wichterle, Dan; Melenovský, Vojtěch; Clemens, Marcell; Fukunaga, Masato; Peichl, Petr; Aldhoon, Bashar; Čihák, Robert; Kautzner, Josef

doi:10.1016/j.jacep.2016.12.010

Cited by 25 publications

(29 citation statements)

References 16 publications

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“…In our study, apelin levels also statistically signifi cantly correlated inversely with left atrial (LA) size, left ventricular diastolic diameter and duration of AF, which might be indirect markers of chronically increased LA stretch. According to our knowledge, this was not studied before, but research from Sramko et al suggested that an increased left atrial pressure in the patients with AF regardless if measured in sinus rhythm was associated with an extensive LA arrhythmogenic substrate (26). Whether patients with paroxysmal AF have chronically increased LA pressure even in sinus rhythm and therefore decreased apelin concentrations merits further research.…”

Section: Discussionmentioning

confidence: 85%

Concentration of apelin inversely correlates with atrial fibrillation burden

Böhm¹,

Urban²,

Tóthová³

et al. 2021

BLL

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AIM: Asymptomatic atrial fi brillation (AF) detection and pulmonary veins isolation (PVI) outcome prediction remain challenging. Our aim was to study the association between apelin and paroxysmal AF in patients undergoing radiofrequency catheter PVI. METHODS: Sixty-three consecutive patients (55 ± 8years, 12 females) with paroxysmal AF without a structural heart disease and implanted ECG loop recorders undergoing PVI and healthy control group of 34 persons (41 ± 9.5years, 21 females) were included. Apelin plasmatic concentrations were measured before and three months after PVI. AF burden was continually assessed for three years. RESULTS: Apelin was signifi cantly decreased in AF patients compared to the healthy controls (0.79 ± 0.09 vs 0.98 ± 0.06 ng/ml; p < 0.00001). Apelin plasmatic concentration of 0.89 ng/ml had 94 % specifi city and 89 % sensitivity for AF prediction with the area under the curve (AUC) of 0.96. After propensity matching to sex, age and comorbidities, apelin concentration was signifi cantly lower in AF group (0.78 ± 0.1 vs 0.99 ± 0.06 ng/ml; p < 0.0001; AUC: 0.97). There was a signifi cant inverse correlation between apelin concentration and AF burden both before and after PVI (Rho =-0.22; p = 0.05) and (Rho =-0.51; p = 0.006), respecti vely. There was no signifi cant association between pre-PVI apelin and PVI long-term outcome. CONCLUSION: In patients without a structural heart disease apelin showed a signifi cant specifi city and sensitivity for AF prediction and inversely correlated with AF burden (Tab.

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Section: Discussionmentioning

confidence: 85%

Concentration of apelin inversely correlates with atrial fibrillation burden

Böhm¹,

Urban²,

Tóthová³

et al. 2021

BLL

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“…The association of hypertension and arrhythmogenic atrial remodelling requiring substrate modification has been shown in previous studies [ 24 ]. In line with this finding, patients with increased LA pressures, as often associated with HTN, also display more extensive arrhythmogenic substrate and higher rates of arrhythmia recurrence [ 25 ]. After successful AF ablation, patients with elevated LA pressure seem to show a greater benefit regarding quality of life than patients without LA pressure elevation [ 25 ].…”

Section: Discussionmentioning

confidence: 87%

“…In line with this finding, patients with increased LA pressures, as often associated with HTN, also display more extensive arrhythmogenic substrate and higher rates of arrhythmia recurrence [ 25 ]. After successful AF ablation, patients with elevated LA pressure seem to show a greater benefit regarding quality of life than patients without LA pressure elevation [ 25 ]. However, whether the direct hemodynamic effects of HTN by elevated atrial strain and atrial pressure or indirect influences by HTN-promoted cardiac comorbidities play the leading role for atrial remodelling has to be evaluated in experimental studies aimed at mechanistic analyses.…”

Section: Discussionmentioning

confidence: 87%

Ablation of Atrial Fibrillation in Patients with Hypertension—An Analysis from the German Ablation Registry

Zylla

Hochadel

Andresen

et al. 2020

JCM

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Background: Hypertension (HTN) constitutes a risk factor for the development of atrial fibrillation (AF), as well as for thromboembolic and bleeding events. We analysed the outcome after catheter ablation of AF in HTN in a cohort from the prospective multicenter German Ablation Registry. Methods: Between 03/2008 and 01/2010, 626 patients undergoing AF-ablation were analysed. Patients diagnosed with HTN (n = 386) were compared with patients without HTN (n = 240) with respect to baseline, procedural and long-term outcome parameters. Results: Patients with HTN were older and more often presented with persistent forms of AF and cardiac comorbidities. Major and moderate in-hospital complications were low. At long-term follow-up, major cardiovascular events were rare in both groups. Rates of AF-recurrence, freedom from antiarrhythmic medication and repeat ablation were not statistically different between groups. Most patients reported improvement of symptoms and satisfaction with the treatment. However, patients with HTN more frequently complained of dyspnea of New York Heart Association (NYHA) class ≥ II and angina. They were more often rehospitalized, particularly when persistent AF had been diagnosed. Conclusion: Catheter ablation of AF is associated with low complication rates and favorable arrhythmia-related results in patients with HTN. Residual clinical symptoms may be due to cardiac comorbidities and require additional attention in this important subgroup of AF-patients.

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“…[ 10 ] These comorbidities have been associated with increased LA pressure in AF patients. [ 41 ] Hypertension is associated with abnormalities in the RAAS with high circulating levels of angiotensin II, ACE, and aldosterone. In addition to the fibrotic mechanism previously discussed, these components contribute to atrial myopathy by affecting ion channel structure and function and cause pro-inflammatory effects on the LA.…”

Section: Pathophysiology Of Atrial Myopathymentioning

confidence: 99%

Atrial Myopathy Underlying Atrial Fibrillation

Rivner

Mitrani

Goldberger

2020

Arrhythmia &Amp; Electrophysiology Review

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While AF most often occurs in the setting of atrial disease, current assessment and treatment of patients with AF does not focus on the extent of the atrial myopathy that serves as the substrate for this arrhythmia. Atrial myopathy, in particular atrial fibrosis, may initiate a vicious cycle in which atrial myopathy leads to AF, which in turn leads to a worsening myopathy. Various techniques, including ECG, plasma biomarkers, electroanatomical voltage mapping, echocardiography, and cardiac MRI, can help to identify and quantify aspects of the atrial myopathy. Current therapies, such as catheter ablation, do not directly address the underlying atrial myopathy. There is emerging research showing that by targeting this myopathy we can help decrease the occurrence and burden of AF.

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Resting and Exercise-Induced Left Atrial Hypertension in Patients With Atrial Fibrillation

Cited by 25 publications

References 16 publications

Concentration of apelin inversely correlates with atrial fibrillation burden

Concentration of apelin inversely correlates with atrial fibrillation burden

Ablation of Atrial Fibrillation in Patients with Hypertension—An Analysis from the German Ablation Registry

Atrial Myopathy Underlying Atrial Fibrillation

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