Identification and electrophysiological characterization of early left atrial structural remodeling as a predictor for atrial fibrillation recurrence after pulmonary vein isolation

Yagishita, Atsuhiko; Sparano, Dina M.; Cakulev, Ivan; Gimbel, John; Phelan, Timothy; Mustafa, Hossam; Oliveira, Samer De; Mackall, Judith A.; Arruda, Maurício

doi:10.1111/jce.13211

Cited by 41 publications

(34 citation statements)

References 36 publications

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“…Slow maturation of proarrhythmogenic substrate, which is being neglected by the current methodology and/or chosen definitions, might be a hypothetical explanation of this phenomenon . Additionally, Yagishita et al identified an upper cutoff of 1.1 mV during electroanatomic voltage mapping as a significant predictor for AF recurrences. Abnormal electrograms in LVAs between 0.5‐1.1 mV were commonly seen in patients with AF recurrence undergoing PVI alone due to the absence of LVAs less than 0.5 mV.…”

Section: Discussionmentioning

confidence: 99%

Significance of inducibility of atrial fibrillation after pulmonary vein isolation in patients with healthy left atrium substrate

Kosiuk

Gründig

Dinov

et al. 2019

Cardiovasc electrophysiol

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Background The significance of the inducibility of atrial fibrillation (AF) after pulmonary vein isolation (PVI) in patients with AF remains disputable and polarizing. Therefore, we investigated the prognostic value of the inducibility of AF on long‐term outcome after PVI in patients without low‐voltage left atrial (LA) substrate. Methods Two hundred forty‐five patients (mean age 59+/−9years, 72% male) without LA low‐voltage areas (defined as electrogram amplitudes <0.5 mV) undergoing first PVI procedure were included in the study. Following successful PVI, inducibility was assessed by burst pacing from coronary sinus with a cycle length (CL) of 300, 250, and 200 ms or the shortest CL resulting in 1:1 atrial capture. During the follow‐up period of up to 3 years, the rhythm outcome was monitored by serial 7‐days Holter electrocardiogram. Results AF was induced in 38 patients (16%). Atypical atrial flutter was observed in six patients (2%), while typical flutter in three cases (1%). Within the first 3 months, early recurrence was diagnosed in 39 patients (16%), while late recurrence was detected in 58 patients (24%) after a mean AF free survival of 28 ± 1 months. While there was no impact on early recurrence, AF inducibility affected long‐term recurrence (31 ± 1 vs 23 ± 3 months; P = .001). In multivariate analysis, AF inducibility (hazard ratio [HR] 2.14; 95% confidence interval [CI], 1.03‐4.45; P = .041) and persistent type of AF (HR 2.17; 95%CI, 1.06–4.47; P = .034) were associated with late AF recurrence. Conclusion In patients without low‐voltage substrate undergoing PVI, AF inducibility is a significant predictor of long‐term outcome. The pathomechanisms of this phenomenon must be further studied to be addressed by additional treatment.

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Section: Discussionmentioning

confidence: 99%

Significance of inducibility of atrial fibrillation after pulmonary vein isolation in patients with healthy left atrium substrate

Kosiuk

Gründig

Dinov

et al. 2019

Cardiovasc electrophysiol

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“…Based on this connection, it is known that voltage-guided substrate modification by targeting LVA in addition to pulmonary vein isolation (PVI) is more effective than conventional PVI approaches [ 8 , 9 , 17 ]. Recently, Yagishita et al showed that already a LA voltage cut-off of <1.1 mV for electro-anatomic voltage mapping in sinus rhythm can be seen as an independent predictor for recurrences in patients without LVA (<0.5 mV) [ 18 ]. Although, LVA is an important risk factor for post-procedural AF recurrences [ 8 , 9 ], there is no standardised method to predict LVA non-invasively before catheter ablation procedure.…”

Section: Discussionmentioning

confidence: 99%

Association between PR interval prolongation and electro-anatomical substrate in patients with atrial fibrillation

et al. 2018

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BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in clinical routine. Left atrial (LA) electro-anatomical remodelling in AF patients indicates disease progression and is associated with poor therapeutic success. PR interval prolongation is associated with an increased risk for AF, however, the association between LA remodelling measured as low voltage areas (LVA) during catheter ablation and PR interval is unknown. The aim of this study was to investigate the association between PR interval prolongation and LVA in AF patients.MethodsWe studied 103 patients (62±12 years, 59% males, 34% persistent AF) undergoing first AF catheter ablation and presenting with sinus rhythm. PR interval prolongation was defined as PR >200ms and analysed in resting ECG before intervention. LVA were determined using high-density maps and defined as <0.5 mV.ResultsThere were 24 patients (23%) with PR interval prolongation and 18 patients (17%) with LVA. There were significant correlations between PR prolongation with LVA, CHA2DS2-VASc score and eGFR (r2 = 0.230, 0.216, and 0.307, all p<0.05). PR interval prolongation (OR 3.450, p = 0.024), persistent AF (OR 5.391, p = 0.002), and LA size (OR 1.117, p = 0.018) were significant predictors for LVA, while age (OR 1.072, p = 0.005), LVA (OR 3.450 p = 0.024) and eGFR (OR 0.962, p = 0.004) were associated with PR interval prolongation.ConclusionsBeside persistent AF and LA size, PR interval prolongation might be useful for the prediction of electro-anatomical substrate in AF patients. Larger studies are needed to confirm these results.

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“…More recently, Yagishita et al. also demonstrated that mildly affected low‐voltage area was independently correlated with AF recurrence . However, whether the whole TZ homogenization or only selective complex electrograms elimination in this region as the adjunctive to scar ablation strategy needs further clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of sole pulmonary vein isolation in patients with nonparoxysmal atrial fibrillation without significant left atrium scar

Shen

Zhai

Yang

et al. 2018

Pacing Clinical Electrophis

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Identification and electrophysiological characterization of early left atrial structural remodeling as a predictor for atrial fibrillation recurrence after pulmonary vein isolation

Cited by 41 publications

References 36 publications

Significance of inducibility of atrial fibrillation after pulmonary vein isolation in patients with healthy left atrium substrate

Significance of inducibility of atrial fibrillation after pulmonary vein isolation in patients with healthy left atrium substrate

Association between PR interval prolongation and electro-anatomical substrate in patients with atrial fibrillation

Efficacy of sole pulmonary vein isolation in patients with nonparoxysmal atrial fibrillation without significant left atrium scar

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