Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy (original) (raw)
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JACC: Clinical Electrophysiology, 2018
OBJECTIVES This study sought to determine if diffuse ventricular fibrosis improves in patients with atrial fibrillation (AF)-mediated cardiomyopathy following the restoration of sinus rhythm. BACKGROUND AF coexists in 30% of heart failure (HF) patients and may be an underrecognized reversible cause of left ventricular systolic dysfunction. Myocardial fibrosis is the hallmark of adverse cardiac remodeling in HF, yet its reversibility is unclear. METHODS Patients with persistent AF and an idiopathic cardiomyopathy (left ventricular ejection fraction [LVEF] #45%) were randomized to catheter ablation (CA) or ongoing medical rate control as a pre-specified substudy of the CAMERA-MRI (Catheter Ablation versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction-an MRI-Guided Multi-centre Randomised Controlled Trial) trial. All patients had cardiac magnetic resonance imaging scans (including myocardial T1 time), serum B-type natriuretic peptide, 6-min walk tests, and Short Form-36 questionnaires performed at baseline and 6 months. Sixteen patients with no history of AF or left ventricular systolic dysfunction were enrolled as normal controls for T1 time. RESULTS Thirty-six patients (18 in each treatment arm) were included in this substudy. Demographics, comorbidities, and myocardial T1 times were well matched at baseline. At 6 months, patients in the CA group had a significant reduction in myocardial T1 time from baseline compared with the medical rate control group (À124 ms; 95% confidence interval [CI]: À23 to À225 ms; p ¼ 0.0176), although it remained higher than that of normal controls at 6 months (p ¼ 0.0017). Improvements in myocardial T1 time with CA were associated with significant improvements in absolute LVEF (þ12.5%; 95% CI: 5.9% to 19.0%; p ¼ 0.0004), left ventricular end-systolic volume (p ¼ 0.0019), and serum B-type natriuretic peptide (À216 ng/l; 95% CI: À23 to À225 ng/l; p ¼ 0.0125). CONCLUSIONS The improvement in LVEF and reverse ventricular remodeling following successful CA of AF-mediated cardiomyopathy is accompanied by a regression of diffuse fibrosis. This suggests timely treatment of arrhythmia-mediated cardiomyopathy may minimize irreversible ventricular remodeling.
Europace, 2010
In patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF), radiofrequency catheter ablation (RFCA) represents a promising option. However, the predictors of RFCA efficacy remain largely unknown. We assessed the outcome of a multicentre HCM cohort following RFCA for symptomatic AF refractory to medical therapy. Methods and results Sixty-one patients (age 54 + 13 years; time from AF onset 5.7 + 5.5 years) with paroxysmal (n ¼ 35; 57%), recent persistent (n ¼ 15; 25%), or long-standing persistent AF (n ¼ 11; 18%) were enrolled. A scheme with pulmonary vein isolation plus linear lesions was employed. Of the 61 patients, 32 (52%) required redo procedures. Antiarrhythmic therapy was maintained in 22 (54%). At the end of a 29 + 16 months follow-up, 41 patients (67%) were in sinus rhythm, including 17 of the 19 patients aged 50 years, with marked improvement in New York Heart Association (NYHA) functional class (1.2 + 0.5 vs. 1.9 + 0.7 at baseline; P , 0.001). In the remaining 20 patients (33%), with AF recurrence, there was less marked, but still significant, improvement following RFCA (NYHA class 1.8 + 0.7 vs. 2.3 + 0.7 at baseline; P ¼ 0.002). Independent predictors of AF recurrence were increased left atrium volume [hazard ratio (HR) per unit increase 1.009, 95% confidence interval (CI) 1.001-1.018; P ¼ 0.037] and NYHA functional class (HR 2.24, 95% CI 1.16-4.35; P ¼ 0.016). Among 11 genotyped HCM patients (6 with MYBPC3, 2 with MYH7, 1 with MYL2 and 2 with multiple mutations), RFCA success rate was comparable with that of the overall cohort (n ¼ 8; 73%). Conclusion RFCA was successful in restoring long-term sinus rhythm and improving symptomatic status in most HCM patients with refractory AF, including the subset with proven sarcomere gene mutations, although redo procedures were often necessary. Younger HCM patients with small atrial size and mild symptoms proved to be the best RFCA candidates, likely due to lesser degrees of atrial remodelling.
Circulation, 2005
Background-Isolated atrial fibrillation (AF) is associated with mild enlargement of the left atrium (LA) and left ventricular (LV) diastolic dysfunction. The impact of ablation of isolated AF on left chamber size and function is unclear, and whether diastolic dysfunction is the cause or the consequence of AF remains unknown. The objective of this prospective study was to evaluate the impact of sinus rhythm restoration by catheter ablation on LV diastolic dysfunction, LA morphology, and mechanical function. Methods and Results-Forty-eight patients with isolated AF were studied by serial echocardiographic studies at baseline and at 1-, 3-, 6-, 9-, and 12-month intervals after radiofrequency ablation. LA dimensions and mechanical function and LV systolic and diastolic functions were evaluated at each time interval. Diastolic function was assessed with conventional Doppler parameters and new indexes such as tissue Doppler imaging, mitral flow propagation velocity, and combined criteria. LV diastolic dysfunction was present in paroxysmal and chronic AF patients with a reduction of tissue Doppler imaging lateral early diastolic peak velocity in 37% (PϽ0.001) and 48% (PϽ0.01), respectively, compared with healthy control subjects. At the end of the follow-up, LA area decreased significantly by 18% (PϽ0.001) in paroxysmal and 23% (PϽ0.05) in chronic AF patients. Diastolic function improved significantly with an increase in lateral early diastolic peak velocity of 29% (PϽ0.001) in paroxysmal AF and 46% (PϽ0.05) in chronic AF patients. A significant increase in LV ejection fraction was also noted for both groups: 7.7% and 18.8%, respectively. Conclusions-This study demonstrates reverse morphological remodeling of the LA and improvement of LV diastolic and systolic functions after restoration of sinus rhythm by ablation for isolated AF. Because patients with isolated AF have none of the traditional causes of LV diastolic dysfunction, our findings suggest that AF may be partly the cause rather than the consequence of diastolic dysfunction. (Circulation. 2005;112:2896-2903.)
The American Journal of Cardiology, 2008
Radiofrequency catheter ablation has been demonstrated to be effective in the treatment of patients with atrial fibrillation. However, its impact on left atrial (LA) function has not been widely studied. The purpose of the present study was to evaluate the impact of radiofrequency catheter ablation on LA function in patients with atrial fibrillation. Thirty-eight patients with symptomatic drug-refractory atrial fibrillation were treated with circumferential pulmonary vein ablation (CPVA). LA volumes and function were assessed with real-time 3-dimensional echocardiography before and 6 months after the procedure. The effectiveness of CPVA was evaluated at 6-month follow-up. Recurrence of the arrhythmia was defined as any documented (clinically or on 24-hour Holter electrocardiography) atrial tachyarrhythmia lasting >30 seconds after the first 12 weeks after the procedure. CPVA induced a reduction of maximum LA volume (from 55 ؎ 15 to 48 ؎ 16 ml, p <0.001), without impairment in LA function, measured as the active emptying percentage of total volume (32 ؎ 29% vs 39 ؎ 33%, p ؍ NS). At follow-up, 21 patients (61.8%) had no recurrences. Maximum LA volumes were significantly larger in patients who presented with recurrences compared with those who did not (64 ؎ 18 vs 50 ؎ 11 ml, p ؍ 0.01). In conclusion, CPVA induces a reduction in LA volume without a deleterious impact on function, and, of importance, real-time 3-dimensional echocardiography is a useful noninvasive imaging tool to follow up LA remodeling and function in these patients.
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.
2007
Background: Clinical, echocardiographic results and determinants of atrial fibrillation (AF) recurrence following AF ablation during mitral valve surgery (AFAMVS) were evaluated. Methods: Fifty-two patients undergoing radiofrequency AFAMVS between January 2003 and December 2005, underwent serial echocardiographies with tissue Doppler imaging to assess atrio-ventricular function. Recurrence of AF, hospital readmission, episodes of congestive heart failure (CHF) were recorded. Predictors for AF-recurrence were evaluated. Results: At a 29.5 AE 8.6 months of follow-up (100% complete), 78.8% patients were in sinus rhythm (SR). Freedom from AF-recurrence was 64.6 AE 0.76%, from hospital readmission 88.9 AE 0.47%, from CHF 91.6 AE 0.63%. SR-patients demonstrated better freedom from hospital readmission (97.4 vs 60.6%; p = 0.0003) and from CHF 72.7%; p = 0.008) during follow-up. At follow-up SR-patients demonstrated left atrial (preoperative 5.8 AE 0.8 cm vs follow-up 5.1 AE 0.9; p = 0.013) and ventricular reverse remodelling (preoperative LVDd 5.7 AE 1.1 cm vs follow-up 5.2 AE 1.1; p = 0.048 -preoperative LVDs 4.0 AE 1.4 vs follow-up 3.6 AE 1.1; p = 0.036). E/A ratio was normal in 73.1% (92.7% of SR-patients). TDI at the level of the left lateral annulus showed an improved left ventricular systole (Sm), and diastole (Em, E/Em) of SR-patients, compared with AF-patients (Sm 9.40 AE 1.74 vs 7.72 AE 1.5, p = 0.0001; Em: 10.45 AE 1.98 vs 7.68 AE 0.72, p = 0.001; E/Em: 0.07 AE 0.02 vs 0.10 AE 0.04, p = 0.0001). Large preoperative atrial diameter (OR = 5.81; p = 0.002), preoperative NYHA-IV (OR = 3.55; p = 0.001), high diuretics at discharge (OR = 1.27; p = 0.03), tricuspid insufficiency at follow-up (OR = 2.31; p = 0.02) were independent predictors of AF-recurrence. Conclusions: Radiofrequency AFAMVS achieves 78.8% of SR recovery. Maintenance of SR improves clinic, haemodynamic and echocardiographic endpoints. Pre-and postoperative cardiac failure is the main determinant of AF-recurrence. #