Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation

Soulat-Dufour, Laurie; Lang, Sylvie; Addetia, Karima; Éderhy, Stéphane; Adavane-Scheublé, Saroumadi; Chauvet-Droit, Marion; Jean, Marie-Liesse; Nhan, Pascal; Said, Rim Ben; Kamami, Iris; Issaurat, Pauline; Capderou, Elodie; Arnaud, Camille; Boccara, Franck; Lang, Roberto M.; Cohen, Ariel

doi:10.1016/j.jacc.2021.12.029

Cited by 93 publications

(70 citation statements)

References 40 publications

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“…We believe this suggests that TEE prior to cardioversion should be required despite anticoagulation therapy to prevent the risk of consequent thromboembolism. As more research continues to show the benefit of early rhythm control in patients with atrial fibrillation, we expect the number of cardioversions to increase over the next decade (Soulat‐Dufour, 2022 ; Kirchhof, 2020 ). We hope to promote further research with large multicenter trials to change the existing guidelines for evaluation of LAAT prior to cardioversion.…”

Section: Discussionmentioning

confidence: 99%

“…Elective cardioversion is a well-established treatment for this potentially fatal arrhythmia (Soulat-Dufour et al, 2022). However, the electro cardioversion procedure itself poses a risk of clot dislodgement.…”

Section: Introductionmentioning

confidence: 99%

“…Oral anticoagulation is known to reduce the incidence of stroke by over 60% in these patients (Airaksinen, 2015 ). Elective cardioversion is a well‐established treatment for this potentially fatal arrhythmia (Soulat‐Dufour et al, 2022 ). However, the electro cardioversion procedure itself poses a risk of clot dislodgement.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of left atrial appendage thrombus despite 3 weeks of anticoagulation and the need for precardioversion echocardiography

Erickson

Yadav

Sneij

et al. 2022

Noninvasive Electrocardiol

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Background: One of the most catastrophic complications of Atrial fibrillation (AF) is thromboembolic stroke. Current guidelines recommend that 3 weeks of anticoagulation is adequate prior to direct current cardioversion (DCCV) to prevent thromboembolism. Here we present data regarding, which anticoagulant is most likely to show a presence of an Left atrial appendage thrombus (LAAT) on trans esophageal echocardiogram (TEE) for DCCV despite 3 weeks of anticoagulation.Objective: To investigate the effectiveness of both vitamin k antagonist (VKA) and direct oral anticoagulants (DOAC) in patients with AF as an anticoagulant for LAAT after 3 weeks of medication.Methods: This is a single-high volume tertiary center, where TEE precardioversion is the standard practice. We reviewed data over 10 months where DCCV was intended on individuals with AF who were fully anticoagulated for at least 3 weeks with either a VKA or taking a DOAC. Results:The data showed a statistical difference between patients who were fully anticoagulated for at least 3 weeks with VKA in comparison to DOACs. Patients on DOACs are significantly less likely to have an LAAT after at least 3 weeks of anticoagulation. OR = 0.04 (CI 95% 0.005-0.42; p-value < .05). Despite anticoagulation for at least 3 weeks, 40% of our patients still had a LAAT. Conclusion:Our data indicates that all patients should be required to undergo a TEE

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence of left atrial appendage thrombus despite 3 weeks of anticoagulation and the need for precardioversion echocardiography

Erickson

Yadav

Sneij

et al. 2022

Noninvasive Electrocardiol

View full text Add to dashboard Cite

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“…Mitral annular enlargement from AF and the LA myopathy in HFpEF has been associated with atrial MR. 82 Observational studies have suggested a decrease in atrial MR with catheter ablation and restoration of sinus rhythm as the LA and annular sizes decrease 68 and improved outcomes with transcatheter mitral repair. However, randomized trials of catheter ablation or transcatheter or surgical MR reduction are not available in patients with atrial MR and HFpEF.…”

Section: Af In Hfpefmentioning

confidence: 99%

“…Patients with atrial MR in COAPT had larger LA volumes and smaller LV volumes despite severe MR volumes, supporting an atrial mechanism of MR, with similar benefit from percutaneous MR reduction. 73 The role of catheter ablation to restore sinus rhythm and annular size and to reduce atrial MR has been demonstrated in observational studies, 68 but there are no randomized data using rhythm control for atrial MR in HFrEF.…”

Section: Atrial Mitral Regurgitation In Hfref and The Impact Of Afmentioning

confidence: 99%

Management of Atrial Fibrillation Across the Spectrum of Heart Failure With Preserved and Reduced Ejection Fraction

2022

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Atrial fibrillation (AF) is the most common arrhythmia among patients with heart failure (HF), and HF is the most common cause of death for patients presenting with clinical AF. AF is frequently associated with pathological atrial myocardial dysfunction and remodeling, a triad that has been called atrial myopathy. AF can be the cause or consequence of clinical HF, and the directionality varies between individual patients and across the spectrum of HF. Although initial trials suggested no advantage for a systematic rhythm control strategy in HF with reduced ejection fraction, recent data suggest that select patients may benefit from attempts to maintain sinus rhythm with catheter ablation. Preliminary data also show a close relationship among AF, left atrial myopathy, mitral regurgitation, and HF with preserved ejection, with potential clinical benefits to catheter ablation therapy. The modern management of AF in HF also requires consideration of the degree of atrial myopathy and chronicity of AF, in addition to the pathogenesis and phenotype of the underlying left ventricular HF. In this review, we summarize the contemporary management of AF and provide practical guidance and areas in need of future investigation.

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Telltale atria—The meaning of adverse remodeling

Eng

Zahr

2023

Cathet Cardio Intervent

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Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation

Cited by 93 publications

References 40 publications

Incidence of left atrial appendage thrombus despite 3 weeks of anticoagulation and the need for precardioversion echocardiography

Incidence of left atrial appendage thrombus despite 3 weeks of anticoagulation and the need for precardioversion echocardiography

Management of Atrial Fibrillation Across the Spectrum of Heart Failure With Preserved and Reduced Ejection Fraction

Telltale atria—The meaning of adverse remodeling

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