Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicentre LAGO-AF study

Bisbal, Felipe; Alarcón, Francisco; Ferrero-de-Loma-Osorio, Ángel; González-Ferrer, Juan José; Alonso, C.; Pachón, Marta; Tizón, Helena; Cabanas‐Grandío, Pilar; Sanchez, Manuel; Benito, Eva; Teis, Albert; Ruiz‐Granell, Ricardo; Pérez-Villacastín, Julián; Viñolas, Xavier; Arias, Miguel Á.; Vallès, Ermengol; García-Campo, Enrique; Fernández‐Lozano, Ignacio; Villuendas, Roger; Mont, Lluı́s

doi:10.1093/ehjci/jey060

Cited by 57 publications

(50 citation statements)

References 17 publications

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“…The present study is a subanalysis of the LAGO study database, which (as previously reported) included patients from January 1 to December 31, 2013, who underwent a first ablation of symptomatic drug‐refractory paroxysmal and persistent AF. Minimum requirements for participating centers included a minimum of 25 AF ablations/year, pulmonary vein isolation (PVI) as procedural endpoint (radiofrequency or cryoenergy), and data collection on baseline, procedural, and follow‐up variables of interest in prospective institutional databases.…”

Section: Methodsmentioning

confidence: 99%

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Diagnosis‐to‐ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome

Bisbal

Alarcón

Ferrero-de-Loma-Osorio

et al. 2019

Cardiovasc electrophysiol

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Introduction Recurrences after atrial fibrillation (AF) ablation are still common. Among the reported clinical and imaging predictors of recurrences, diagnosis‐to‐ablation time (DAT) has been defined as a predictor of ablation outcome in single‐center studies. We aimed to validate DAT in a multicenter real‐life cohort. Methods This was a multicenter study including consecutive patients undergoing first paroxysmal and persistent AF ablation with radiofrequency or cryoballoon catheters during 2013. Cox proportional hazard regression models were performed to identify predictors of recurrence. Results In total, 309 patients were included across nine centers (71% men, 57 ± 10 years old, 46% with hypertension, and 66% with CHA2DS2‐VASc ≤ 1). Most patients had paroxysmal AF (67%) and underwent radiofrequency ablation (68%) with a median DAT of 51 (43) months. Patients with DAT ≤ 1 year (16.6%) were less likely to have repeat procedures (4% vs 18%; P = .017). The adjusted proportional hazards Cox model identified hypertension (P = .005), heart failure (P = .011), nonparoxysmal AF (P = .038), DAT > 1 year (P = .007), and LA diameter (P = .026) as independent predictors for AF recurrence. DAT > 1 year was the only modifiable factor independently associated with recurrence (HR 4.2 [95% CI, 1.5‐11.9]) Conclusion Diagnosis‐to‐ablation time is a modifiable factor independently associated with recurrent arrhythmia and repeat ablation after first AF ablation. An early intervention strategy during the first year from AF diagnosis might improve outcomes.

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Section: Methodsmentioning

confidence: 99%

“…Ablation is considered the treatment of choice for symptomatic drug‐refractory atrial fibrillation (AF) . The success of the procedure is highly dependent on the patient's risk factors, AF phenotype, and left atrial (LA) remodeling . From the clinical perspective, patient selection remains the first step to improve ablation outcome.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis‐to‐ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome

Bisbal

Alarcón

Ferrero-de-Loma-Osorio

et al. 2019

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%

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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“…Этот процесс приводит к появлению множественных мелких очагов циркуляции возбуждения (re-entry), которые благоприятствуют развитию и рецидивированию ФП. В ряде исследований установлено, что развитие электрических патологических процессов в миокарде предшествует механическим [27,28]. Выявлены корреляции электромеханического ремоделирования миокарда с частотой возникновения ФП [28].…”

Section: роль аг в патогенезе формирования фпunclassified

“…В ряде исследований установлено, что развитие электрических патологических процессов в миокарде предшествует механическим [27,28]. Выявлены корреляции электромеханического ремоделирования миокарда с частотой возникновения ФП [28]. Более того, некоторыми исследователями параметры ремоделирования ЛП, определяемые при Speckle-tracking эхокардиографии, такие как «вертикальная асимметрия ЛП» и «сферичность ЛП», отражающие нарушение механических свойств, повышенную жесткость, сниженную диастолическую релаксацию, выделены в качестве предикторов рецидива ФП после аблации [27,28].…”

Section: роль аг в патогенезе формирования фпunclassified

Atrial fibrillation and hypertension: current understanding of the pathogenesis, diagnosis, and treatment

Киргизова

Баталов

Татарский

et al. 2019

SMJ

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The present literature review is devoted to the analysis of the features of the pathogenesis of atrial fibrillation in patients with arterial hypertension and to the optimal treatment tactics in this cohort of patients. In particular, pathological mechanisms (hemodynamic, structural, and electrophysiological) of the development of atrial fibrillation in arterial hypertension are reviewed. The article highlights the problems of primary and secondary prevention of atrial fibrillation using antihypertensive therapy as well as the aspects of the prevention of thromboembolic complications in patients with atrial fibrillation and arterial hypertension.

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Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicentre LAGO-AF study

Abstract: NCT02373982 (http://clinicaltrials.gov/ct2/show/NCT02373982).

Cited by 57 publications

References 17 publications

Diagnosis‐to‐ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome

Diagnosis‐to‐ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome

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

Atrial fibrillation and hypertension: current understanding of the pathogenesis, diagnosis, and treatment

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