Atrial fibrillation and cardiac fibrosis

Sohns, Christian; Marrouche, Nassir F.

doi:10.1093/eurheartj/ehz786

Cited by 182 publications

(128 citation statements)

References 105 publications

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“…Several observations have led to new insights in AF management and arrhythmia‐associated cardiac remodeling. AF is a progressive disease that is not only a consequence of structural, hemodynamic, and electrophysiological remodeling, but also a cause of the same processes 4 . One of the markers of LA remodeling is the dilation of the atrial structure in AF patients, which was also found to be a positive predictor of AF/AT recurrence in our study.…”

Section: Discussionsupporting

confidence: 72%

Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Bergau

Hamriti

Rubarth

et al. 2020

Cardiovasc electrophysiol

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Introduction Cryoballoon (CB)‐guided ablation of atrial fibrillation (AF) is established in symptomatic AF patients. This study sought to determine the safety and efficacy of CB pulmonary vein isolation (PVI) in young adults. Methods and Results A total of 93 consecutive patients aged <45 years referred to our center for AF ablation were included in this observational study. All patients received CB‐guided PVI according to a standardized institutional protocol. Follow‐up was performed in our outpatient clinic using 72‐h Holter monitoring and periodic telephone interview. Recurrence was defined as any AF/atrial tachycardia (AT) episode >30 s following a 3‐month blanking period. A propensity matched control group consisting of patients older than 45 years were used for further evaluation. Mean age was 35 ± 7 years, 22% suffered from persistent AF, 85% were male. Mean follow‐up was 2.6 ± 2 years. At the end of the observational period, 83% of patients were free of any AF/AT episodes. There was an excellent overall 12‐month success rate of 92%. In comparison to a matched group the overall recurrence rate was noticeably lower in the young group (15% vs. 27%). Increasing age was associated with a hazard ratio of 1.16 for recurrence. In a multivariate analysis model, left atrial diameter remained as significant predictor of AF/AT recurrence. The complication rate was low, no permanent phrenic nerve palsy was observed. Conclusion CB‐guided PVI in young adults is safe and effective with favorable long‐term results. It may be considered as first‐line therapy in this relatively healthy population.

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Section: Discussionsupporting

confidence: 72%

Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Bergau

Hamriti

Rubarth

et al. 2020

Cardiovasc electrophysiol

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“…It seems that patients with higher sphericity indexes have an 11 times higher risk of developing 1-year post-CA recurrences as compared to those with discoid LA [22]. In the LAGO-AF study, the LA sphericity index emerged as the sole independent predictor of recurrences [22][23][24]. Subsequently, geometrical structural remodelling may be superior to size in predicting CA outcomes and arrhythmia recurrences.…”

Section: Left Atrial Shapementioning

confidence: 99%

“…Late-gadolinium enhancement CMR (LGE-CMR) is the gold standard in assessing myocardial fibrosis [15,23]. A gadolinium-based contrast agent enhances fibrosis detection due to its accumulation in the extracellular space (increased in fibrotic tissues) and its delayed clearance.…”

Section: Left Atrial Fibrosismentioning

confidence: 99%

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

et al. 2020

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Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase “AF begets AF”. A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.

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“…B. durch Wearables und Implantables) eine wichtige Rolle für individuelle Therapiekonzepte. (Nach [22], mit freundlicher Genehmigung von Oxford Academic)…”

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Smart and simple

Sohns

Khalaph

Bergau

et al. 2020

Herzschr Elektrophys

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Smart and simple Stellenwert von Implantables und Wearables im rhythmologischen Alltag Im Rahmen der Digitalisierung besteht die Möglichkeit, Herzrhythmusstörungen in einem relevanten Umfang über sog. Implantables und Wearables zu detektieren. Diese Geräte produzieren eine erhebliche Datenmenge und geben einen Einblick in das, was in unserem Körper vor sich geht. Es ist nicht überraschend, dass diese Geräte zunehmend an Popularität gewinnen, da viele Menschen nun die direkte Möglichkeit haben, individuelle Veränderungen, Fortschritte, aber auch Rückschritte kontinuierlich und quantitativ zu erfassen und darauf zu reagieren.

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Atrial fibrillation and cardiac fibrosis

Cited by 182 publications

References 105 publications

Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

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