Progression of atrial remodeling in patients with high-burden atrial fibrillation: implications for early ablative intervention

Walters, Tomos E., Nisbet, Ashley, Morris, Gwilym M., Tan, Gabriel, Mearns, Megan, Teo, Eliza, Lewis, Nigel, Ng, AiVee, Gould, Paul, Lee, Geoffrey, Joseph, Stephen, Morton, Joseph B., Zentner, Dominica, Sanders, Prashanthan, Kistler, Peter M. and Kalman, Jonathan M. (2016) Progression of atrial remodeling in patients with high-burden atrial fibrillation: implications for early ablative intervention. Heart Rhythm, 13 2: 331-339. doi:10.1016/j.hrthm.2015.10.028

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Author Walters, Tomos E.
Nisbet, Ashley
Morris, Gwilym M.
Tan, Gabriel
Mearns, Megan
Teo, Eliza
Lewis, Nigel
Ng, AiVee
Gould, Paul
Lee, Geoffrey
Joseph, Stephen
Morton, Joseph B.
Zentner, Dominica
Sanders, Prashanthan
Kistler, Peter M.
Kalman, Jonathan M.
Title Progression of atrial remodeling in patients with high-burden atrial fibrillation: implications for early ablative intervention
Journal name Heart Rhythm   Check publisher's open access policy
ISSN 1556-3871
1547-5271
Publication date 2016-02-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.hrthm.2015.10.028
Open Access Status File (Author Post-print)
Volume 13
Issue 2
Start page 331
End page 339
Total pages 9
Place of publication Philadelphia, PA United States
Publisher Elsevier
Collection year 2016
Language eng
Formatted abstract
Background

Advanced atrial remodeling predicts poor clinical outcomes in human atrial fibrillation (AF).

Objective

The purpose of this study was to define the magnitude and predictors of change in left atrial (LA) structural remodeling over 12 months of AF.

Methods

Thirty-eight patients with paroxysmal AF managed medically (group 1), 20 undergoing AF ablation (group 2), and 25 control patients with no AF history (group 3) prospectively underwent echocardiographic assessment of strain variables of LA reservoir function at baseline and at 4, 8, and 12 months. In addition, P-wave duration (Pmax,, Pmean) and dispersion (Pdis) were measured. AF burden was quantified by implanted recorders. Twenty patients undergoing ablation underwent electroanatomic mapping (mean 333 ± 40 points) for correlation with LA strain.

Result

Group 1 demonstrated significant deterioration in total LA strain (26.3% ± 1.2% to 21.7% ± 1.2%, P < .05) and increases in Pmax (132 ± 3 ms to 138 ± 3 ms, P < .05) and Pdis (37 ± 2 ms to 42 ± 2 ms, P < .05). AF burden ≥10% was specifically associated with decline in strain and with P-wave prolongation. Conversely, group 2 manifest improvement in total LA strain (21.3% ± 1.7% to 28.6% ± 1.7%, P <.05) and reductions in Pmax (136 ± 4 ms to 119 ± 4 ms, P < .05) and Pdis (47 ± 3 ms to 32 ± 3 ms, P < .05). Change was not significant in group 3. LA mean voltage (r = 0.71, P = .0005), percent low voltage electrograms (r = –0.59, P = .006), percent complex electrograms (r = –0.68, P = .0009), and LA activation time (r = –0.69, P = .001) correlated with total strain as a measure of LA reservoir function.

Conclusion

High-burden AF is associated with progressive LA structural remodeling. In contrast, AF ablation results in significant reverse remodeling. These data may have implications for timing of ablative intervention.
Keyword Atrial fibrillation
Atrial remodeling
Strain imaging
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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