Association of echocardiographic atrial size and atrial fibrosis in a sequential model of congestive heart failure and atrial fibrillation

Knackstedt, Christian; Gramley, Felix; Schimpf, Thomas; Mischke, Karl; Zarse, Markus; Plisienė, Jurgita; Schmid, Michael; Lorenzen, Johann; Frechen, Dirk; Neef, Philipp; Hanrath, Peter; Kelm, Malte; Schauerte, Patrick

doi:10.1016/j.carpath.2007.12.003

Cited by 54 publications

(39 citation statements)

References 26 publications

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“…In addition, aging-related increase in angiotensin II, oxidative stress and inflammation can contribute to AF via atrial fibrosis as well as through ventricular fibrosis and diastolic dysfunction [58][59][60]. Accordingly, pharmacological strategies for the prevention of AF with agents that target the renin-angiotensin system (RAS), inflammation, oxidative injury and atrial fibrosis such as angiotensinconverting enzyme (ACE) inhibitors, angiotensin type 1 receptor blockers (ARBs), statins and poly unsaturated fatty acids (PUFAs) have attracted attention.…”

Section: Atrial Fibrillation and Left Atrial Remodelingmentioning

confidence: 99%

Atrial fibrillation and heart failure in the elderly

2011

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Atrial fibrillation (AF) is a common clinical problem in elderly patients and especially in those with heart failure (HF). It is a major risk factor for serious cardiovascular events, such as stroke, HF and premature death. Both the prevalence and incidence of AF increase with age and its prevalence in the United States are estimated at more than 2.2 million, with nearly 75% of patients aged >65 years. Aging-related atrial remodeling with fibrosis, dilation and mitochondrial DNA mutations predispose elderly patients to AF. Current management options for AF, including rate control and anticoagulation therapy, can be successfully applied to the elderly population. New antiarrhythmic and anticoagulation medications such as dronedarone and dabigatran, respectively, can impact the approach to therapy in the elderly. Non-pharmacological options such as catheter-based ablation have also gained prominence and have been incorporated into the guidelines for management of AF. However, more trials in the elderly and very elderly segments are needed to clarify the safety and long-term efficacy of the new treatment options.

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Section: Atrial Fibrillation and Left Atrial Remodelingmentioning

confidence: 99%

Atrial fibrillation and heart failure in the elderly

2011

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“…Aging and LA size are significantly associated with AF progression in most relevant reports. [23][24][25][26] In addition, several studies have documented that age and LA size are associated with atrial fibrosis, 26,28,29 which may result in increased, nonuniform anisotropy and local conduction heterogeneity, 30 thus playing a key role in promoting the perpetuation of AF. 29,30 In addition, we demonstrated that patients could be stratified before the initial CA by combining these 2 parameters (age …”

Section: Clinical Predictors Of Af Progressionmentioning

confidence: 99%

Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation

Takigawa

Takahashi

Kuwahara

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— Although catheter ablation (CA) is a standard treatment for atrial fibrillation (AF), its long-term efficacy remains unclear. This study aimed to elucidate the incidences of AF recurrence and of progression from paroxysmal to persistent AF, after CA, in patients with paroxysmal AF. Methods and Results— We examined the incidence of AF recurrence and AF progression in 1220 consecutive patients (mean age, 61 years), with symptomatic paroxysmal AF, undergoing CA, based on extensive pulmonary vein isolation and focal ablation for nonpulmonary vein foci. AF recurrence–free survival probabilities at 5 years were 59.4% after the initial CA and 81.1% after the final CA (average, 1.3 procedures). During a median follow-up period of 47.9 (range, 5.3–123.3) months after the initial CA, AF progressed from paroxysmal to persistent in 15 (1.2%) patients (0.3%/y). The duration of AF history (hazard ratio [HR], 1.03; P <0.0001), number of ineffective antiarrhythmics (HR, 1.09; P =0.005), and left atrial diameter indexed by the body surface area (HR, 1.05; P =0.001) were significant predictors of AF recurrence. Patient age (HR, 1.12; P =0.0001) and left atrial diameter indexed by the body surface area (HR, 1.26; P =0.0006) were significantly associated with AF progression. Patients aged ≤65 years and with a left atrial diameter indexed by the body surface area of ≤24.0 mm/m 2 did not develop AF progression for ≤10 years after the initial CA. Conclusions— Although the long-term follow-up revealed the effect of CA on preventing AF recurrence, repeated CA sessions might be required. The rate of progression from paroxysmal to persistent AF was 0.3%/y.

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“…Finally, the extent of fibrosis was not examined directly or quantitatively in this study. Several studies revealed the correlation between LA fibrosis and the size 22 and further assessment with new modalities such as MRI may be warranted.…”

Section: Limitationsmentioning

confidence: 99%

Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

Takigawa

Yamada

Yoshida

et al. 2012

J Renin Angiotensin Aldosterone Syst

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Introduction: The purpose of this study was to investigate whether the effects of renin-angiotensin system inhibitors (RASIs) after encircling ipsilateral pulmonary veins isolation (EIPVsI) for atrial fibrillation (AF) differed between patients with non-dilated and dilated left atria. Materials and methods: We retrospectively studied 292 consecutive patients (mean age=61±11 years, 75% males) who underwent successful EIPVsI for paroxysmal or persistent AF. RASIs' effects were compared between the patients with a non-dilated left atrium of <40 mm (n=178) and dilated left atrium of ≥40 mm (n=114). Results: During a mean follow-up period of 18.9±12.7 months, AF recurred in 38 (21.4%) and 45 (39.5%) patients with non-dilated and dilated left atria, respectively. A multivariate Cox proportional analysis revealed that treatment with RASIs (hazard ratio (HR) 0.30, 95% confidence interval (CI) =0.13-0.66, p=0.003), the duration of AF (HR 1.08/year, 95% CI=1.01-1.16, p=0.03), a history of hypertension (HR 2.86, 95% CI=1.21-6.85, p=0.02) and the left ventricular ejection fraction (HR 0.54/10%↑, 95% CI=0.34-0.87, p=0.01) were associated with AF recurrences in patients with a non-dilated left atrium. On the other hand, only the duration of AF (HR 1.11/year, 95% CI=1.01-1.21, p=0.03) was associated with AF recurrences in those with a dilated LA, and RASIs had no effect on AF recurrences (p=0.65). Conclusions: RASIs suppressed AF recurrences after EIPVsI only in patients with a non-dilated left atrium.

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Association of echocardiographic atrial size and atrial fibrosis in a sequential model of congestive heart failure and atrial fibrillation

Cited by 54 publications

References 26 publications

Atrial fibrillation and heart failure in the elderly

Atrial fibrillation and heart failure in the elderly

Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation

Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

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