Efficacy of Pulmonary Vein Isolation on Left Atrial Function in Paroxysmal and Persistent Atrial Fibrillation and the Dependency on Its Baseline Function

Yoshida, Naoyasu; Okamoto, Masahiro; Hirao, Hidekazu; Suenari, Kazuyoshi; Nanba, Kiyomi; Kinoshita, Hiroki; Matsumura, Masaya; Uchida, Mio; Kinoshita, Mirai; Watari, Yuichiro; Fukuda, Yukihiro; Ueda, Hironori

doi:10.1111/echo.12143

Cited by 9 publications

(11 citation statements)

References 29 publications

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“…19,20,[26][27][28] Our results are in accordance with a study by Morris et al 19 using LA strain pattern using echocardiographic measures, showing that AF ablation outcomes are correlated with the LA systolic and diastolic function. In another report, PV flow velocities measured by echocardiography were inversely associated with recurrence after CA in a relatively small study of 67 AF patients.…”

Section: Discussionsupporting

confidence: 91%

“…In another report, PV flow velocities measured by echocardiography were inversely associated with recurrence after CA in a relatively small study of 67 AF patients. 20 Another small study on 63 patients using speckled tracking on echocardiogram showed LA longitudinal strain as an independent predictor of recurrence after CA for AF. 26 A recent investigation by Motoki et al 27 showed 42% recurrence after initial AF ablation after a median of 8 months of follow-up in 256 In this study, LA diastolic function was estimated by constructing PV loops for a large sample of AF ablation patients who were followed prospectively.…”

Section: Discussionmentioning

confidence: 98%

“…[19][20][21] Most studies on LA diastolic function have used echocardiographic speckle tracking to assess strain and indirectly evaluate myocardial compliance. 19,22 Other groups have investigated the atrial diastolic function by CMR, again based entirely on changes in LA volume.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

Khurram

Maqbool

Berger

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Atrial fibrillation (AF) is associated with significant abnormalities of left atrial (LA) systolic and diastolic function. This study describes a novel measure, LA stiffness index, that estimates LA diastolic function and its association with clinical outcomes of catheter ablation. Methods and Results-A total of 219 AF patients referred for ablation (59% paroxysmal, mean CHA 2 DS 2 VASc score 1.7±1.4) were enrolled. Atrial pressure and volume loops were prepared from invasive pressure measures and cardiac magnetic resonance imaging volumetric data during sinus rhythm for all patients. An LA stiffness index was created, defined by the ratio of change in LA pressure to volume during passive filling of LA (ΔP/ΔV). Patients were followed prospectively. Mean LA stiffness index for AF patients was 0.6±0.5 mm Hg/mL (paroxysmal AF 0.51±0.4 and persistent AF 0.73±0.6; P<0.001). Linear regression analysis showed a rise in the stiffness index with age, increasing at a rate of 0.02 mm Hg/mL per year (P<0.001). The LA stiffness index was higher in patients with previous LA ablation(s) for AF (0.51±0.35 versus 0.83±0.70; P<0.001). Forty of 160 patients had recurrence after AF ablation with a mean follow-up of 10.4±7.6 months. Patients with recurrence had higher stiffness index than those without recurrence (0.83±0.46 versus 0.40±0.22; P<0.001). Conclusions-LA stiffness index, a novel measure to assess LA diastolic function, increases with age and is higher in persistent AF and in the setting of repeat AF ablation. Greater LA stiffness index was independently associated with recurrence of AF after LA ablation. (Circ Arrhythm Electrophysiol. 2016;9:e003163.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

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Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

Khurram

Maqbool

Berger

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…For this reason, PVCs are a clinically-recognized source of pro-arrhythmic signals in the heart [15]. Ablation procedures are routinely used by clinicians to electrically isolate pulmonary veins from the posterior wall of the left atrium (the border of the two tissues) and they are highly successful in treating acute and sustained AF [16,17]. Studies using different types of cardiac cells have implicated spontaneous Ca 2 + signals as a likely cause of pro-arrhythmic activity [6,18,19].…”

Section: Pulmonary Vein Sleeve Cells Show Spontaneous Action Potentiamentioning

confidence: 99%

“…Conclusion: spontaneous Ca 2 + transients and action potentials disrupt the normal cardiac Ca 2 + signals in cardiac myocytes, which can lead to arrhythmia and atrial fibrillation It is very clear that PVCs make a significant contribution to the onset of AF in humans [17,[24][25][26]. Electrical mapping studies have shown that PVCs trigger APs during the normally quiescent diastolic period [27] and that these APs can propagate into the left atrium via the junction of the atrium and pulmonary vein.…”

Section: Individual Pulmonary Vein Sleeve Cells Differ In Their Pattementioning

confidence: 99%

Pulmonary vein sleeve cell excitation–contraction-coupling becomes dysynchronized by spontaneous calcium transients

Rietdorf

Masoud

McDonald

et al. 2015

Biochemical Society Transactions

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Atrial fibrillation (AF) is the most common form of sustained cardiac arrhythmia. Substantial evidence indicates that cardiomyocytes located in the pulmonary veins [pulmonary vein sleeve cells (PVCs)] cause AF by generating ectopic electrical activity. Electrical ablation, isolating PVCs from their left atrial junctions, is a major treatment for AF. In small rodents, the sleeve of PVCs extends deep inside the lungs and is present in lung slices. Here we present data, using the lung slice preparation, characterizing how spontaneous Ca2+ transients in PVCs affect their capability to respond to electrical pacing. Immediately after a spontaneous Ca2+ transient the cell is in a refractory period and it cannot respond to electrical stimulation. Consequently, we observe that the higher the level of spontaneous activity in an individual PVC, the less likely it is that this PVC responds to electrical field stimulation. The spontaneous activity of neighbouring PVCs can be different from each other. Heterogeneity in the Ca2+ signalling of cells and in their responsiveness to electrical stimuli are known pro-arrhythmic events. The tendency of PVCs to show spontaneous Ca2+ transients and spontaneous action potentials (APs) underlies their potential to cause AF.

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Embryology and Anatomy of the Left Atrial Appendage

Kanmanthareddy

Reddy

Vallakati

et al. 2014

Interventional Cardiology Clinics

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Efficacy of Pulmonary Vein Isolation on Left Atrial Function in Paroxysmal and Persistent Atrial Fibrillation and the Dependency on Its Baseline Function

Abstract: The baseline LA function may affect AF recurrence as well as the improvement of LA function, and the benefit of successful PV isolation might be greater in CAF than in PAF.

Cited by 9 publications

References 29 publications

Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

Pulmonary vein sleeve cell excitation–contraction-coupling becomes dysynchronized by spontaneous calcium transients

Embryology and Anatomy of the Left Atrial Appendage

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