Multimodality imaging assessment of the Biatrial remodeling of the burden of atrial high-rate episodes in patients with cardiac implanted electronic devices

Abstract

AimsThe underlying mechanisms of atrial remodeling in cardiac implanted electronic device(CIED)-detected atrial high-rate episodes(AHRE) remains to be elucidated. MethodsA cardiac computed tomography and a strain echocardiography were performed to delineate the structural and functional characteristics of both atria. Biatrial volumes, emptying fraction(EF) and peak atrial longitudinal/contractile strain(PALS/PACS) were evaluated. All AHRE were analyzed. ResultsA total of 80 CIED patients with AHRE were categorized by AHRE duration into 3 groups: Group 1: <6 min(n = 42), Group 2: 6 min ∼ 6 h(n = 23), and Group 3: >6 h(n = 15). Left atrial(LA) maximal volume(Vmax), atrial precontraction volume(Vapc), minimal volume(Vmin), LAEF, and PALS/PACS were all increasingly worsened among the patients in the 3 groups (p value for trend <0.05).Compared to Group 1, Group 2 had decreased LA PALS/PACS. There was no significant difference in LA volume or EF between Group 1 and 2. Group 3 had enlarged biatrial volumes (LAVmax: 57.1(SD 16.0) vs. 45.4(SD 9.2) mL/m2, p = 0.002; LAVmin: 42.6(SD 18.2) vs. 28.2(SD 7.2) mL/m2, p < 0.001), impaired total LAEF (28.0(SD 13.7) vs. 38.2(SD 7.7)%, p = 0.004) and reduced PALS/PACS compared to Group 1. Atrial remodeling in those with AHRE >6 h had increased LA volumes, impaired LAEF and reduced PALS/PACS compared to those with AHRE <6 h. ConclusionFunctional remodeling of the atria manifested after AHRE >6 min. Increased biatrial volumes and decreased LA reservoir and pump function occurred when AHRE were > 6 h. These LA structural and functional may be considered surrogate imaging markers for stroke risk assessment in patients with CHA2DS2-VASc ≥2 and AHRE.