Dilated Cardiomyopathy Atrial Fibrillation Research Articles

Atrial fibrillation in dilated cardiomyopathy: Outcome prediction from an observational registry

BackgroundLittle is known about the role of different types of atrial fibrillation (AF) in dilated cardiomyopathy (DCM). We investigated the epidemiological and prognostic impact of different types of AF in DCM during long-term follow-up. MethodWe evaluated consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry. Uni- and multivariable, extended Kaplan-Meier and propensity score-matching analyses were performed for a composite outcome including death/heart transplantation/ventricular-assist device implantation. ResultsOut of 1181 DCM patients (71% males, age 49 ± 15 years, left ventricular ejection fraction 33 ± 11%), 46 (3.9%) had baseline permanent AF (permAF), while 66 (5.6%) had a history of paroxysmal/persistent AF. Compared with sinus rhythm (SR) patients, permAF patients were older (48 ± 15 vs. 61 ± 11 respectively, p = 0.001), were more frequently in NYHA class III-IV (18% vs. 30%, p = 0.002) and had larger left atrium diameter (40 ± 8 vs. 50 ± 10 mm, respectively). Paroxysmal/persistent AF patients had intermediate characteristics between permAF and SR. During a median follow-up of 135 (75–210) months, 63 patients developed permAF (0.45 new cases/100patients/year). At multivariable analysis, permAF as a time-dependent variable was an independent outcome predictor (HR 2.45; 95% C.I. 2.61–3.63, p < 0.001), together with creatinine, NYHA class, restrictive filling pattern and moderate-severe mitral regurgitation, while paroxysmal/persistent AF was neutral. Propensity score-matching analysis confirmed the higher rate of primary outcome events in patients with baseline or incident permAF versus patients without permAF during a very long-term follow-up (70% vs. 20%, p < 0.001). ConclusionsPermAF in a large DCM cohort had low prevalence and incidence but had a relevant.prognostic role on hard outcomes.

The burden of atrial fibrillation and its prognostic value in patients with dilated cardiomyopathy.

Atrial fibrillation (AF) is the most common arrhythmia in patients with dilated cardiomyopathy (DCM). However, the epidemiology as well as clinical and prognostic significance of AF in DCM are poorly defined. We aimed to assess the impact and prognostic value of AF in DCM as well as to investigate the concept of AF‑induced DCM. Hospital records of 285 patients with DCM from 2012 to 2018 with follow-up were analyzed. Atrial fibrillation was present in 89 patients (31%). They were older, more frequently male, hadhigher body mass index, New York Heart Association class, heart rate (HR), creatinine levels, and larger atria (all P < 0.05) than patients without AF. During follow‑up (mean [SD], 35 [24] months), death occurred in 20 of the 82 available patients with AF and 22 of the 188 patients without AF (24% and 12%, respectively; P = 0.007). Atrial fibrillation was independently associated with a worse outcome (hazard ratio, 2.4; 95% CI, 1.3-4.3) and was found to be the major cause of DCM in 21 patients (24%). The diagnostic accuracy of the most optimal predictive model for AF‑induced DCM was 0.935 (95% CI, 0.903-0.967). Despite numerical differences, survival was similar in DCM patients with and without AF (P = 0.15). Almost one‑third of patients with DCM had AF. Most of the parameters analyzed differed between patients with and without AF, and AF was found to be an independent prognostic factor of DCM. One‑fourth of patients with DCM and AF met the diagnostic criteria for AF‑induced DCM.

527Myocardial fibrosis is a predictor of atrial fibrillation in dilated cardiomyopathy- role of cardiovascular magnetic resonance

Methods 44 consecutive pts (38±11 years-old, 29 men) with DCM were included, after exclusion of ischemic heart disease (coronary angiography), secondary cardiomyopathies (clinical and laboratory investigation), non-sinus rhythm and contraindications to CMR. Functional class and plasmatic NT-pro-BNP were assessed. All pts underwent CMR: a) short-axis SSFP for left atrial area and left ventricle (LV) volumes and ejection fraction (EF); b) LGE (segmented inversion-recovery fast gradient-echo sequence), 10-15 mn after 0.2mmol/kg of Gd-DTPA acquired in long-axis and short-axis views; LGE was classified as subendocardial or midwall and quantified using plannimetry of LGE contours, 6SD from remote myocardium; a fibrosis index was obtained from LGE volume/myocardial volume. All underwent 24-hours Holter monitoring, less than one month from CMR, and the number of atrial fibrillation episodes was assessed. Results 26 pts were in NYHA class II and 18 in class III. Mean NT-pro-BNP was 551±180pg/ml, atrial area was 35.8±11.0 cm2, LV end-diastolic volume was 155 ±44mL/m2, mean EF was 33±8%. LGE was found in 29 patients (69%) located in midwall, involving a mean of 7 segments per pt (range 3-14). Holter monitoring showed AF episodes in 26 pts. In comparison with pts without AF, pts with AF had higher NT-pro-BNP (836±110 vs 474±132 pg/ml, p=0.01), larger atrial area (44.1±10.1 vs 31.2±9,2 cm2, p=0.002), larger LV end-diastolic volumes (172±31 vs 153±35ml/m2, p=0.03) and more frequent LGE (p=0.0003). In pts with AF, no correlation was found between the functional class or the fibrosis index and the number of AF episodes. Using multivariate analysis, the atrial area and the presence of LGE were independent predictors of occurrence of AF episodes.

Long-term outcomes of catheter ablation of atrial fibrillation in dilated cardiomyopathy

ObjectiveThe long-term outcomes, efficacy and safety of catheter ablation in atrial fibrillation (AF) patients with dilated cardiomyopathy (DCM) have not been reported previously. Methods and resultsForty nine patients with AF (59% longstanding persistent AF, LSP-AF) and DCM were enrolled. Circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs, persistent and LSP-AF) were the endpoints of the index and repeat procedures. Cumulative success rate reached 49% (mean, 1.4 procedures) during the first year, and dropped to 38% at median follow-up of 45months (range, 36–64months) for multiple procedures (mean, 1.9±0.8 [1–4]). Incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, LSP-AF (OR, 7.40 [95% CI, 1.42–38.34]; P=0.017) and larger left ventricular end-diastolic diameter (OR, 1.24 [95% CI, 1.01–1.52]; P=0.034) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa). Compared with patients with ATa recurrence, those free from ATa had better New York Heart Association functional class, 6-minute walk distance and left ventricular ejection fraction during long-term follow-up compared with pre-ablation, but this improvement was not sustained beyond 3years. ConclusionIn patients with DCM, current commonly used ablation strategies including CPVA, linear ablation and CFAE ablation are not associated with long-term AF treatment success up to five years. Freedom from ATa is associated with improved heart failure during but not beyond 3years post ablation.

Myocardial fibrosis is a predictor of atrial fibrillation in dilated cardiomyopathy. Role of cardiovascular magnetic resonance

Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) has been found in about two-thirds of patients with dilated cardiomyopathy (DCM). The clinical impact of this finding is not well established.