The Atrium in Atrial Fibrillation – A Clinical Review on How to Manage Atrial Fibrotic Substrates

Cunha, Pedro Silva; Laranjo, Sérgio; Heijman, Jordi; Oliveira, Mário

doi:10.3389/fcvm.2022.879984

Cited by 25 publications

(14 citation statements)

References 362 publications

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“…LA dilation is a well-established risk factor for predicting outcomes in AF patients after the procedure [1]. Increased LA size is associated with a higher recurrence rate of AF treated with ablation [2]. However, not all AF patients with LA dilation will develop LASEC during TEE.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Implications of Left Atrial Spontaneous Echo Contrast with Catheter Ablation of Nonvalvular Atrial Fibrillation Patients with Left Atrial Dilation

Lin

Bao

Xie

et al. 2022

JCDD

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Background: Left atrial spontaneous echo contrast (LASEC) can be detected by transesophageal echocardiography (TEE) before the catheter ablation of atrial fibrillation (AF), especially in patients with left atrial (LA) dilation. Whether LASEC has prognostic value in predicting the procedure outcomes in patients with an enlarged atrium is unknown. The prognostic implications of LASEC with the catheter ablation of AF patients with LA dilation will be evaluated in this study. Methods: AF patients scheduled to undergo catheter ablation in Ruijin Hospital, Shanghai, China, between January 2018 and June 2020 were screened for this prospective study. All patients underwent TEE before the procedure. Patients with a left atrial diameter (LAD; 45 mm ≤ LAD < 50 mm) and left atrial volume (LAV ≥ 120 mL) were enrolled in this study. The endpoint was AF/atrial tachycardia (AT) recurrence-free survival following a 3-month blanking period after the catheter ablation. All patients were followed up for 18 months. Results: This study included 123 AF patients, who were divided into the LASEC (n = 73) and no LASEC (n = 50) groups. Baseline patient characteristics were similar in the two groups. At the end of 18 months of follow-up, AF/AT recurrence-free survival was achieved in 33 (45.2%) and 34 (68.0%) patients in the LASEC and no LASEC groups, respectively (p = 0.013). In survival analysis, the LASEC group was also associated with a poor outcome of catheter ablation (log-rank test, p = 0.011; Cox regression, p = 0.015, HR = 2.058, 95%CI = 1.151–3.679). Meanwhile, during the follow-up AF/AT recurrence was observed in 30 (57.7%) and 15 (71.4%) cases in the mild and severe SEC groups, respectively. Ischemic stroke occurred in two patients in the LASEC group. Conclusions: LASEC could be a predictor of the recurrence of AF/AT after catheter ablation in AF patients with LA dilation. The higher the degree of LASEC, the worse the prognosis.

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Section: Introductionmentioning

confidence: 99%

Prognostic Implications of Left Atrial Spontaneous Echo Contrast with Catheter Ablation of Nonvalvular Atrial Fibrillation Patients with Left Atrial Dilation

Lin

Bao

Xie

et al. 2022

JCDD

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“…The current study found that steerable sheath was used more often in patients requiring PVI in addition to supplementary ablations on other locations, such as fibrotic areas, tricuspid isthmus, and left atrium roof, that are difficult for a fixed curve sheath to reach using a fixed curve sheath. For example, box isolation of fibrotic areas is usually implemented with PVI in patients with fibrotic atrial cardiomyopathy (FACM) to improve ablation outcomes ( 13 ). Because anterior fibrotic areas are more common and larger than posterior fibrotic areas in AF patients with FACM ( 14 ), it would be much easier for the bi-directional VIZIGO sheath to steer the catheter from the pulmonary vein entrance to the anterior wall of the left atrium.…”

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness and efficiency of a new steerable sheath technology for radiofrequency ablation in Chinese patients with atrial fibrillation: a retrospective comparative cohort study

Zhao¹,

Zhang²,

Peng³

et al. 2023

J Thorac Dis

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Background The clinical effectiveness and efficiency of a steerable sheath for radiofrequency catheter ablation (RFCA) in Chinese patients with atrial fibrillation (AF) needs to be compared with a fixed curve sheath to optimize RFCA procedure. Methods This retrospective study included adult AF patients with their first RFCA that was conducted by the same electrophysiologist using a steerable sheath (VIZIGO, Biosense Webster, Inc.) or a fixed curve sheath (NaviEase, Synaptic Medical) in a Chinese tertiary care hospital from January to November 2021. The medical records kept at the hospital were the source of study data that included patient baseline characteristics and outcome measures for the clinical effectiveness and efficiency of RFCA procedure. Multivariate generalized linear regression analyses were performed to explore the impact of sheath type on clinical effectiveness and efficiency after adjustment. Results Fourteen patients using steerable sheath and 34 patients using fixed curve sheath for RFCA were included in the data analysis. Most of patient baseline characteristics associated with the two study groups were comparable except that the steerable sheath group had significantly higher left atrium diameter (41.9±6.5 vs. 38.1±3.9 mm, P=0.017) and larger left atrium volume (150.4±29.5 vs. 126.8±27.5 mL, P=0.017) than the fixed curve sheath group. Using steerable sheath was associated with significantly shorter total pulmonary vein isolation (PVI) fluoroscopy time and post-surgery hospital length of stay (LOS) than using fixed curve sheath in both unadjusted comparisons (PVI fluoroscopy time: 1.3±1.5 vs. 4.0±3.9 min, P=0.004; post-surgery LOS: 2.1±0.7 vs. 2.9±1.5 days, P=0.034) and multivariate generalized regression analyses (PVI fluoroscopy time: coefficient =−0.859, P=0.014; post-surgery LOS: coefficient =−0.303, P=0.018). Conclusions Compared to fixed curve sheath, steerable sheath used for RFAC could have the potential to shorten the PVI fluoroscopy time and reduce post-surgery LOS in a Chinese real-world hospital setting. Future real-world studies with large sample size are needed to confirm our study findings.

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“…Atrial fibrillation (AF) and HF frequently coexist and complicate one another [ 149 , 150 ], as both conditions share pathophysiological mechanisms and common risk factors [ 151 ]. Underlying mechanisms of AF involve structural remodeling characterized by atrial enlargement and tissue fibrosis [ 152 , 153 ]. In experimental murine models, osteopontin has recently been implicated in atrial fibrosis [ 154 ].…”

Section: Osteopontin In Heart Failurementioning

confidence: 99%

Clinical and Molecular Implications of Osteopontin in Heart Failure

Mamazhakypov

Sartmyrzaeva

Sarybaev

et al. 2022

CIMB

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The matricellular protein osteopontin modulates cell–matrix interactions during tissue injury and healing. A complex multidomain structure of osteopontin enables it not only to bind diverse cell receptors but also to interact with various partners, including other extracellular matrix proteins, cytokines, and growth factors. Numerous studies have implicated osteopontin in the development and progression of myocardial remodeling in diverse cardiac diseases. Osteopontin influences myocardial remodeling by regulating extracellular matrix production, the activity of matrix metalloproteinases and various growth factors, inflammatory cell recruitment, myofibroblast differentiation, cardiomyocyte apoptosis, and myocardial vascularization. The exploitation of osteopontin loss- and gain-of-function approaches in rodent models provided an opportunity for assessment of the cell- and disease-specific contribution of osteopontin to myocardial remodeling. In this review, we summarize the recent knowledge on osteopontin regulation and its impact on various cardiac diseases, as well as delineate complex disease- and cell-specific roles of osteopontin in cardiac pathologies. We also discuss the current progress of therapeutics targeting osteopontin that may facilitate the development of a novel strategy for heart failure treatment.

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The Atrium in Atrial Fibrillation – A Clinical Review on How to Manage Atrial Fibrotic Substrates

Cited by 25 publications

References 362 publications

Prognostic Implications of Left Atrial Spontaneous Echo Contrast with Catheter Ablation of Nonvalvular Atrial Fibrillation Patients with Left Atrial Dilation

Prognostic Implications of Left Atrial Spontaneous Echo Contrast with Catheter Ablation of Nonvalvular Atrial Fibrillation Patients with Left Atrial Dilation

Clinical effectiveness and efficiency of a new steerable sheath technology for radiofrequency ablation in Chinese patients with atrial fibrillation: a retrospective comparative cohort study

Clinical and Molecular Implications of Osteopontin in Heart Failure

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