Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation

Maille, Baptiste; Das, Moloy; Hussein, Ahmed; Shaw, Matthew; Chaturvedi, Vivek; Williams, Emmanuel Ato; Morgan, Maureen; Ronayne, Christina; Snowdon, Richard; Gupta, Dhiraj

doi:10.1007/s10840-019-00576-1

Cited by 20 publications

(26 citation statements)

References 20 publications

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“…This may suggest that the postoperative reduction in PV area can be explained by the effect of shrinkage of the LA. It is generally known that the reverse remodeling of the LAs occurs after successful PV isolation for AF 3–5 . Khidr et al reported that reduction in PV cross‐sectional areas correlated with the LA volume reduction after PV isolation by RFA and suggested that reverse remodeling of the PVs reflects that of the LA 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary vein (PV) stenosis after CBA is reported to be relatively small in magnitude; several risk factors have been mentioned in prior reports 1,2 . Although postoperative PV and left atrium (LA) shrinkage have been reported after PV isolation, 3–5 no studies have clarified the relationship between anatomical changes in PVs and LA along with PV stenosis. Moreover, the actual incidence of PV stenosis and the details of risk predictors vary across reports and remain controversial 2,6 …”

Section: Introductionmentioning

confidence: 99%

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Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

Miyama

Takatsuki

Hashimoto

et al. 2020

Pacing Clinical Electrophis

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Background: The anatomical changes in pulmonary veins (PVs) after cryoballoon ablation (CBA) are unclear. We aimed to determine the morphological changes in the PVs and left atrium (LA) along with the predictive factors for clinical PV stenosis. Methods: We analyzed data of 320 PVs from 80 patients who underwent CBA for atrial fibrillation (age: 62 ± 10 years, 59 males). All patients underwent pre-and postprocedural cardiac computed tomography. We defined clinical PV stenosis when the cross-sectional area decreased by more than 50%. Results: The average ostial PV area and LA volume decreased significantly after CBA (pre-vs post-CBA; 2.4 ± 1.0 cm 2 vs 2.3±1.1 cm 2 , P < .001, 75.0 ± 23.2 cm 3 vs 70.7 ± 21.9 cm 3 , P < .001, respectively). There was a significant correlation between the reduction rates of the PV area and those of LA volume (R = 0.411, P < .001). The larger preoperative PV area and greater reduction in LA volume were associated with advanced PV narrowing. Clinical PV stenosis was observed in six PVs, was more common in females (male vs female; 0.8% vs 4.8%, P = .043), and tended to be more frequent in left PVs (left PVs vs right PVs; 3.1% vs 0.6%: P = .107), irrespective of the LA volume reduction. Conclusions: The significant reduction of the ostial PV area occurred after CBA, which correlated with the reduction rate of LA volume. The narrowing of the PV was partly produced by the LA volume reduction. Clinical PV stenosis was more common in females and tended to be more frequent in left PVs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

Miyama

Takatsuki

Hashimoto

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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“…Under both methods, the reversal of AER contributes to the success rate after ablations, although the mechanisms of them are dissimilar. To date, the time course and pattern of AER are still not entirely clear 7 . There has been limited information on AER after ablation for PAF regarding short‐term trends, mostly in animal or in vitro experiments, and immediate trends, only from surface electrocardiogram studies in vivo 8‐11 .…”

Section: Introductionmentioning

confidence: 99%

“…There has been limited information on AER after ablation for PAF regarding short‐term trends, mostly in animal or in vitro experiments, and immediate trends, only from surface electrocardiogram studies in vivo 8‐11 . Electrophysiological studies and mappings always placed emphasis on long‐term trends after months or a year 7 . There are few comparative data on immediate trends of AER in patients after different ablations.…”

Section: Introductionmentioning

confidence: 99%

The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation

Hou

Feng

Yang

et al. 2021

Clinical Cardiology

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Background Catheter ablation has emerged as a major strategy for paroxysmal atrial fibrillation (PAF). Atrial electrical remodeling (AER) plays a critical role in the recurrence of PAF after ablation. Hypothesis To characterize the immediate trends of AER during ablations in patients with PAF, and assess the relationship between immediate trends and recurrence. Methods We performed this prospective observational study of 135 patients to investigate AER following three ablation modes: radiofrequency ablation (RFA), cryoablation (CA) and 3D mapping‐guided cryoablation (3D‐CA). The atrial effective refractory period (AERP) and atrial conduction time (ACT) were measured via electrophysiology before and immediately after ablation, and P‐wave indices were measured via electrocardiography before and within 24 h after ablation. Follow‐up visits were conducted for at least 1 year or until relapse. Results Different approaches of ablation caused a fairly significant increase in the shortest P‐wave duration and AERP in both the proximal coronary sinus (PCS) and distal coronary sinus (DCS) but caused a shortened P‐wave dispersion. No different effect was found at the AERP among the three modes. Compared to patients who received CA, among patients who received RFA, a significant reduction in total ACT and right ACT was seen. Statistically, there was a weakly positive association between changes in total ACT and early recurrence. Conclusions Injury during ablation for PAF was associated with an increase in the AERP but not in the ACT. Total ACT and right ACT were shorter after RFA than after CA. The increase in total ACT were slightly predictive of early recurrence.

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“…It produces a large number of oxygen free radicals and peroxides in the process of oxidation-reduction in vivo. Active oxygen then directly affects calmodulin to cause intracellular calcium overload, change atrial ion channels and promote atrial electrical remodeling [12,13]. Galectin-3 is a member of the galectin family and can be expressed in many organs, such as the small intestine, spleen, colon and kidney, as well as in inflammatory cells such as mast cells [14], neutrophils and macrophages [15].…”

Section: Introductionmentioning

confidence: 99%

Correlation between serum homocysteine, Galectin-3 concentration and atrial structural remodeling in atrial fibrillation patients

Sun

Liang

et al. 2020

Pteridines

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Objective To investigate the correlation between serum homocysteine (Hcy), Galectin-3 concentration and atrial structural remodeling in atrial fibrillation (AF) patients.Methods Twenty-five patients with persistent atrial fibrillation (PeAF), 24 patients with paroxysmal atrial fibrillation (PaAF) and 23 healthy controls were included in the present work. All subjects received an echocardiography examination. Serum concentration of Hcy and Galectin-3 were also examined by Enzyme Linked Immunosorbent Assay (ELISA).Results Echocardiography examination demonstrated that there were significant differences for LAD (p=0.002), LVEF (p=0.005) and LVAI (p=0.0001) between the control, PaAF and PeAF groups. However, LVSD and LVDD were not significantly different between the three groups (pall>0.05). There was a significant positive correlation between LAVI and serum Hcy level in both PaAF (rpearson=0.49, p=0.016) and PeAF (rpearson=0.51, p=0.009) groups. The correlation between LAVI and serum Galectin-3 concentration was also statistically significant for PaAF (rpearson=0.54, p=0.006) and PeAF (rpearson=0.60, p=0.001) groups. Using serum Hcy as reference, diagnostic sensitivity and specificity were calculated as 72.00 (95%CI: 50.61-87.93) and 62.50 (95%CI: 40.59-81.20), respectively, with an AUC of 0.68 for PaAF and PeAF. For serum Galectin-3, the sensitivity and specificity values were 64.00 (95%CI:42.52-82.03) and 66.67 (95%CI:44.68-84.37), respectively, with an AUC of 0.68.Conclusion: Serum Hcy and Galectin-3 were elevated in AF patients and thus may be potential markers of atrial structural remodeling. However, the diagnostic efficacy of PeAF from PaAF was limited by low AUC values.

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Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation

Cited by 20 publications

References 20 publications

Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation

The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation

Correlation between serum homocysteine, Galectin-3 concentration and atrial structural remodeling in atrial fibrillation patients

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