Abstract
BackgroundAtrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function. We sought to investigate the relationship of anatomical and functional parameters obtained by cardiovascular magnetic resonance (CMR), with AF recurrence in paroxysmal AF (pAF) patients after catheter ablation.MethodsWe studied 80 consecutive pAF patients referred for ablation, between January 2014 and December 2019, who underwent pre- and post-ablation CMR while in sinus rhythm. LA volumes were measured using the area–length method and included maximum, minimum, and pre-atrial-contraction volumes. CMR-derived LA reservoir strain (ℇR), conduit strain (ℇCD), and contractile strain (ℇCT) were measured by computer assisted manual planimetry. We used a multivariate logistical regression to estimate the independent predictors of AF recurrence after ablation.ResultsMean age was 58.6 ± 9.4 years, 75% men, mean CHA2DS2-VASc score was 1.7, 36% had prior cardioversion and 51% were taking antiarrhythmic drugs. Patients were followed for a median of 4 years (Q1–Q3 = 2.5–6.2 years). Of the 80 patients, 21 (26.3%) patients had AF recurrence after ablation. There were no significant differences between AF recurrence vs. no recurrence groups in age, gender, CHA2DS2-VASc score, or baseline comorbidities. At baseline, patients with AF recurrence compared to without recurrence had lower LV end systolic volume index (32 ± 7 vs 37 ± 11 mL/m2; p = 0.045) and lower ℇCT (7.1 ± 4.6 vs 9.1 ± 3.7; p = 0.05). Post-ablation, patients with AF recurrence had higher LA minimum volume (68 ± 32 vs 55 ± 23; p = 0.05), right atrial volume index (62 ± 20 vs 52 ± 19 mL/m2; p = 0.04) and lower LA active ejection fraction (24 ± 8 vs 29 ± 11; p = 0.05), LA total ejection fraction (39 ± 14 vs 46 ± 12; p = 0.02), LA expansion index (73.6 ± 37.5 vs 94.7 ± 37.1; p = 0.03) and ℇCT (6.2 ± 2.9 vs 7.3 ± 1.7; p = 0.04). Adjusting for clinical variables in the multivariate logistic regression model, post-ablation minimum LA volume (OR 1.09; CI 1.02–1.16), LA expansion index (OR 0.98; CI 0.96–0.99), and baseline ℇR (OR 0.92; CI 0.85–0.99) were independently associated with AF recurrence.ConclusionSignificant changes in LA volumes and strain parameters occur after AF ablation. CMR derived baseline ℇR, post-ablation minimum LAV, and expansion index are independently associated with AF recurrence.
Highlights
Atrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function
Additional file 1 shows comparison graphs of baseline and post-ablation reservoir and contractile strain in AF recurrence and no-recurrence groups. In this retrospective study, we evaluated the association of cardiovascular magnetic resonance (CMR) derived LA anatomical and functional parameters in paroxysmal AF (pAF) patients with AF recurrence after catheter ablation
Our main finding were that: (1) pulmonary vein isolation (PVI) leads to a decrease in LA volumes with a decrease in all LA strain parameters (2) baseline Reservoir strain (ƐR) and post-ablation minimum LAV and LA expansion index are independently associated with AF recurrence
Summary
Atrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function. LA remodelling in AF patients is characterized by LA wall inflammation and fibrosis, an increase in the LA size/volumes, and decrease in LA function [3]. Dynamic changes in the LA volumes during ventricular systole, diastole and atrial contraction are represented as reservoir, conduit and booster/contractile function respectively. These LA phasic volumes are influenced by cardiac rhythm and most accurate measurements of LA volumes are performed when patients are in sinus rhythm [4]. These LA parameters can be measured by two dimensional echocardiography (2DE), three dimensional echocardiography (3DE), tissue Doppler imaging, cardiac computed tomography and cardiovascular magnetic resonance (CMR) of which CMR is considered the gold standard [5,6,7,8]
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