Reverse Remodeling of the Left Cardiac Chambers After Catheter Ablation After 1 Year in a Series of Patients With Isolated Atrial Fibrillation (original) (raw)
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The American Journal of Cardiology, 2009
Isolated paroxysmal atrial fibrillation (AF) is commonly associated with left ventricular (LV) diastolic dysfunction but normal radial systolic contraction. We aim to investigate LV systolic function more precisely using 2-dimensional strain technique in patients with isolated paroxysmal AF and to evaluate evolution of longitudinal, circumferential, and radial (or transverse) strain components after catheter ablation of AF. Thirty patients with isolated paroxysmal AF were investigated by echocardiographic studies before and at 1-day, 1-month, 6-month, and 12-month intervals after radiofrequency ablation. Left heart dimensions and LV systolic and diastolic functions were evaluated at each time interval. LV systolic function was quantified by LV ejection fraction and by 2-dimensional strain evaluation, giving regional and global longitudinal, circumferential, transverse, and radial peak of percentage deformation. Patients with AF were compared with 30 control subjects, paired by age and by sex. Before AF ablation, LV ejection fraction, transverse and radial strains were not significantly different from control subjects. By contrast, global longitudinal and circumferential strains were significantly lower than controls (؊17.7% ؎ 2.4% vs ؊21.5% ؎ 2.0% [p <0.01] and ؊16.0% ؎ 2.9% vs ؊20.7% ؎ 3.4% [p <0.01], respectively). At the end of follow-up, global longitudinal and circumferential strains were significantly improved (؊20.8% ؎ 2.6% vs ؊17.7% ؎ 2.4% (p <0.01) and ؊18.5% ؎ 3.1% vs ؊16.0% ؎ 2.9% [p <0.05], respectively). Global longitudinal strain was not significantly different from normal control subjects at the end of follow-up. In conclusion, this prospective study demonstrates (1) the existence of early longitudinal and circumferential LV systolic function abnormalities in patients with isolated paroxysmal AF but normal ejection fraction and (2) reverse remodeling of these abnormalities after AF ablation.
International Journal of Cardiology, 2015
Left atrium (LA) dilatation is associated with atrial fibrillation (AF) progression . Recent data though revealed that atrial remodeling not only involves enlargement but symmetry changes too, which have been associated with reduced success after catheter ablation . Despite the growing evidence of LA remodeling and the need for additional ablation targets in patients with persistent AF, the relation of LA asymmetry and long-term outcomes is still not well studied.
PubMed, 2008
Introduction: The management of patients with heart failure and atrial fibrillation (AF) is a medical challenge, especially in the case of patients in whom sinus rhythm or rate control cannot be achieved with optimal pharmaceutical treatment. Methods: Thirteen consecutive patients (11 men and 2 women, 35-70 years old, median age 55 +/- 23 years) with heart failure (NYHA I-IV, median ejection fraction 35 +/- 5%, range 25-40%) and symptomatic persistent (10 patients, 76.9%) or permanent (3 patients, 23.1%) AF, underwent circumferential ablation using a system of electroanatomic mapping with contact. Circumferential ablation, encircling the pulmonary veins in pairs, and linear ablation between the left and right superior pulmonary vein and along the mitral isthmus were performed. Follow up included 24-hour Holter monitoring and transthoracic echocardiogram at 1, 3, 6, 9 and 12 months. Results: Eight patients (62%) remained in sinus rhythm at the end of the follow up and had achieved a statistically significant improvement in ejection fraction (from 37.5 8.75% to 60.0 +/- 3.75%, p = 0.011), reduction of left ventricular end-diastolic diameter (from 63.0 +/- 3.25 mm to 56.5 +/- 1.75 mm, p = 0.011) and reduction of left atrial diameter (from 49.0 +/- 5.5 mm to 44.5 +/- 4.25 mm, p = 0.011). In contrast, patients with relapse of AF had none of the above changes (p > 0.05). Prognostic indexes of AF recurrence appeared to be the failure to improve ejection fraction (p = 0.003), non-reversal of left ventricular (p = 0.002) and left atrial (p = 0.006) remodelling, a shorter energy application time (p = 0.030) and the presence of coronary artery disease (p = 0.035). None of the patients suffered any complication from the procedure. Conclusion: AF ablation in selected patients with heart failure and low ejection fraction is a relatively effective method of maintaining sinus rhythm, improving left ventricular systolic function and reversing atrial and ventricular remodelling.
Circulation Journal, 2010
he presence and severity of diastolic dysfunction might increase the risk of atrial fibrillation (AF). 1-3 The assessment of the diastolic function in patients with AF allows for the prediction of the clinical outcomes such as hospitalization, stroke and mortality. Patients with AF and heart failure with a preserved left ventricular ejection fraction (LVEF) have been shown to have a greater incidence of diastolic dysfunction, recurrence of heart failure hospitalizations and death. 4 Furthermore, left ventricular diastolic dysfunction was also a determinant of ischemic strokes in the patients with AF. 5 However, the relationships between the diastolic dysfunction, left atrial (LA) substrate and outcome of catheter ablation are not clear. The aim of the current study was to explore the relationships between the diastolic dysfunction, atrial substrate and outcome of catheter ablation. Methods Eighty-three patients with paroxysmal AF who presented with sinus rhythm during an echocardiographic study and catheter ablation were enrolled. There were 55 men and 28 women. The mean patient age was 53.2±12.4 years and the duration of follow-up was 24.0±12.0 months. Echocardiography All patients underwent comprehensive Doppler and M-mode transthoracic echocardiography (SONOS 5500 Echocardiograph; Hewlett Packard Inc, Agilent Technologies, Andover, MA, USA) during sinus rhythm before the catheter ablation according to the recommendations of the American Society of Echocardiography. These techniques have been described
Pacing and Clinical Electrophysiology, 2020
Introduction: A recent study reported diffuse left ventricular (LV) fibrosis is a predictor of atrial fibrillation (AF) recurrence following catheter ablation, by measuring post-contrast cardiac T 1 (an error prone metric as per the 2017 SCMR consensus statement) using an inversion-recovery pulse sequence (an error prone method in arrhythmia) in AF ablation candidates. The purpose of this study was to verify the prior study, by measuring extracellular volume fraction (ECV) (an accurate metric) using a saturation-recovery pulse sequence (accurate method in arrhythmia). Methods and Results: This study examined 100 AF patients (mean age=62±11 years, 69 males and 31 females, 67 paroxysmal [pAF] and 33 persistent [peAF]) who underwent a pre-ablation cardiovascular magnetic resonance (CMR). LV ECV and LA and LV functional parameters were quantified using standard analysis methods. During an average follow-up period of 457±261 days with 4±3 rhythm checks per patient, 72 patients maintained sinus rhythm. Between those who maintained sinus rhythm (n=72) and those who reverted to AF (n=28), the only clinical characteristic that was significantly different was age (60 ± 12 years vs.66 ± 9 years); for CMR metrics, neither mean LV ECV (25.1 ± 3.3% vs. 24.7±3.7%), native LV T1 (1093.8 ± 73.5 ms vs. 1070.2 ± 115.9 ms), LVEF (54.1 ± 11.2% vs. 55.7±7.1%), or LA EDV/BSA (42.4 ± 14.8 mL/m 2 vs. 43.4±19.6 mL/m 2) was not significantly different (p ≥ 0.23). According to Cox regression tests, none of the clinical and imaging variables predicts AF recurrence.
Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy
JACC: Clinical Electrophysiology, 2019
OBJECTIVES This study sought to determine the long-term right atrial (RA) electrical and structural changes in a subgroup from the CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction-Magnetic Resonance Imaging) study. BACKGROUND Catheter ablation (CA) is successful in restoring ventricular function in patients with atrial fibrillation (AF) and otherwise unexplained cardiomyopathy, as demonstrated in the randomized study of CA versus rate control (CAMERA-MRI). It is unknown if this is associated with atrial remodeling. METHODS Detailed electroanatomical (EA) mapping of the RA using CARTO3 and a force sensing catheter was performed at initial CA and electively at least 12 months after CA in patients with >90% reduction in AF burden following ablation. Bipolar voltage, fractionation, and conduction velocity were collected in 4 segments together with echo and cardiac magnetic resonance imaging. RESULTS Fifteen patients (mean age 59.1 AE 6.8 years) underwent repeat RA EA mapping. At a mean follow-up of 23.4 AE 11.9 months, left ventricular (LV) ejection fraction improved from 33.6 AE 3.2% to 54.1 AE 3.2% (p ¼ 0.001), RA area decreased from 28.4 AE 2.0 cm 2 to 20.8 AE 1.2 cm 2 (p < 0.001), and left atrial area decreased from 32.9 AE 2.3 cm 2 to 26.8 AE 1.4 cm 2 (p ¼ 0.007). On EA mapping, RA bipolar voltage increased from 1.6 AE 0.1 mV to 1.9 AE 0.1 mV (p ¼ 0.04). Tissue voltage increased across all regions, which achieved statistical significance at the posterior (p ¼ 0.002) and septal (p ¼ 0.01) segments. There was a significant decrease in complex fractionated electrograms from 21.7 AE 3.5% to 8.3 AE 1.8% (p ¼ 0.002); however, no significant change occurred in global or regional conduction velocities (p ¼ 0.5). CONCLUSIONS Recovery of atrial electrical and structural changes was observed following restoration of sinus rhythm and recovery of LV function in patients who underwent CA for persistent AF and LV systolic dysfunction. The randomized CAMERA MRI study demonstrated significant improvement in LV systolic function with AF ablation compared with rate control. The present study demonstrated reverse electrical and structural atrial recovery in concert with recovery of LV systolic function at 2 years post-AF ablation. This may partially explain the long-term success of CA in patients with AF and otherwise unexplained cardiomyopathy.