The Effect of Catheter Ablation on Left Atrial Size and Function for Patients with Atrial Fibrillation: An Updated Meta-Analysis

Xiong, Bin; Li, Dan; Wang, Jianling; Gyawali, Laxman; Jing, Jinjin; Li, Su

doi:10.1371/journal.pone.0129274

Cited by 34 publications

(32 citation statements)

References 43 publications

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“…Previous meta‐analysis has revealed a decreased LAV after successful AFCA, indicating the positive effect of rhythm control on LA structural reverse remodeling . The LA structural reverse remodeling can be divided into two categories: significant and nonsignificant reverse remodeling .…”

Section: Discussionmentioning

confidence: 99%

“…A ROC curve was plotted and shown in 6,7 The LA structural reverse remodeling can be divided into two categories: significant and nonsignificant reverse remodeling. 14,15 The former refers to a reduction in LAV greater than or equal to 15% while the latter less than 15%.…”

Section: Simple Linear Regression Analysismentioning

confidence: 99%

“…Results from a number of studies showed that LA volume (LAV) was significantly decreased after successful catheter ablation of AF (AFCA) . In contrast, recent studies have found a significant increase in LAV after left atrial appendage closure (LAAC), which might be linked with the reduced LA compliance after the closure of LAA.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

Gong

Zhao

et al. 2019

Cardiovasc electrophysiol

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Introduction Catheter ablation of atrial fibrillation (AFCA) and left atrial appendage closure (LAAC) exert opposite effects on left atrial (LA) size. We aim to observe the net impact of combined AFCA and LAAC strategy on LA size and explore those factors which might affect the postprocedure LA structural remodeling. Methods A total of 53 patients, who underwent combined AFCA and Watchman LAAC in our center from March to December 2017, were enrolled. Atrial fibrillation (AF) recurrence was monitored after the procedure. Left atrial volume (LAV) and left atrial appendage volume (LAAV) were measured by Mimics based on dual‐source computed tomography images. Results At 6 months, sinus rhythm (SR) was maintained in 79.2% patients. LAV was significantly reduced (130.2 ± 36.3 mL to 107.1 ± 30.0 ml; P < .001) in SR maintenance group, but not in AF recurrence group (138.8 ± 39.3 mL to 137.9 ± 36.9 mL; P = .671). In SR group, preoperative LAAV/LAV ratio (B = −0.894; P = .015), NT‐proBNP (B = 0.005; P = .019) and left ventricular ejection fraction (LVEF) (B = −0.778; P < .001) could interactively affect the extent of postoperative LA structural reverse remodeling, among which LAAV/LAV ratio could independently predict the significance of reverse remodeling (≥15% reduction in LAV) (OR, 0.56; 95% CI, 0.34‐0.90; P = .018). A preoperative LAAV/LAV ratio less than 7.1% is indicative of significant LA structural reverse remodeling in this patient cohort. Conclusions LA structural reverse remodeling could be evidenced in patients with maintained SR following combined AFCA and LAAC. Smaller LAAV/LAV ratio, higher NT‐proBNP or lower LVEF at baseline are associated with more significant LA structural reverse remodeling, while LAAV/LAV ratio can predict the significance of the process after one‐stop treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Simple Linear Regression Analysismentioning

confidence: 99%

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Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

Gong

Zhao

et al. 2019

Cardiovasc electrophysiol

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“…20 were also calculated. 14,21 On the basis of previous findings, the predefined cutoff of Max-LAVi for recurrence of AF was set at a Max-LAVi ≥ 34 mL/m 2 . 2…”

Section: Echocardiographic Examinationmentioning

confidence: 99%

Combined assessment of left atrial volume parameters for predicting recurrence of atrial fibrillation following pulmonary vein isolation in patients with paroxysmal atrial fibrillation

et al. 2019

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Objectives:Our aim was to test the hypothesis that comprehensive simplified left atrial (LA) assessment derived from routine echocardiography may be more useful than assessment of LA volume alone for predicting atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Methods:We studied 156 patients with paroxysmal AF (PAF) who had undergone PVI. Echocardiography was performed within two days before PVI. Maximum (Max-LAVi) and minimum LA volume index (Min-LAVi) were calculated with the biplane modified Simpson's method, and then normalized to the body surface area. On the basis of previous findings, the predefined cutoff value of Max-LAVi for AF recurrence was set at Max-LAVi ≥ 34 mL/m 2 . ΔLA volume index (ΔLAVi) was also calculated as Max-LAVi minus Min-LAVi. The follow-up period after PVI was 24 months. Results: AF recurrence was observed in 35 patients. Multivariate logistic regression analysis showed that ΔLAVi (odds ratio [OR]: 1.131; 95% confidence interval [CI]:1.057-1.221; P < 0.001) was an independent predictor of AF recurrence. Sequential logistic regression models for predicting AF recurrence revealed that a model based on clinical variables including age, gender and AF duration (χ 2 = 1.65) was improved by the addition of Max-LAVi ≥ 34 mL/m 2 (χ 2 = 13.8; P < 0.001), and further improved by the addition of ΔLAVi (χ 2 = 18.2; P = 0.036). Of note is that only 1.02 ± 0.10 minutes per patient was needed to obtain a comprehensive LA assessment that included Max-LAVi, Min-LAVi, and ΔLAVi. Conclusion:This easy-to-use comprehensive simplified LA approach from routine echocardiography may well have clinical implications for better management of PAF patients. K E Y W O R D Satrial fibrillation, echocardiography, left atrium | 863 SOGA et Al.

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“…(Jeevanantham et al, 2010) A more recent meta-analysis of 25 studies using echocardiography, cardiac CT and cardiac MR in 2040 patients with paroxysmal and persistent AF found similar overall trends (lower LA diameter and volumes without a change in EF); however, left atrial ejection fraction decreased significantly in patients with paroxysmal AF. (Xiong et al, 2015) Focusing on the most severe end of the disease spectrum, Cochet recently reported long-term followup (>5 years) of patients with persistent AF who required >2 procedures on average; in these patients, active emptying was strongly and negatively correlated with both the cumulative duration of RF pulses used in the ablation procedures and the amount of scar quantified from contrast-enhanced MRI. (Cochet et al, 2014)…”

Section: Ablation Of Atrial Fibrillationmentioning

confidence: 99%

Making better scar: Emerging approaches for modifying mechanical and electrical properties following infarction and ablation

Holmes

Laksman

Gepstein

2016

Progress in Biophysics and Molecular Biology

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Following myocardial infarction (MI), damaged myocytes are replaced by collagenous scar tissue, which serves an important mechanical function – maintaining integrity of the heart wall against enormous mechanical forces – but also disrupts electrical function as structural and electrical remodeling in the infarct and borderzone predispose to re-entry and ventricular tachycardia. Novel emerging regenerative approaches aim to replace this scar tissue with viable myocytes. Yet an alternative strategy of therapeutically modifying selected scar properties may also prove important, and in some cases may offer similar benefits with lower risk or regulatory complexity. Here, we review potential goals for such modifications as well as recent proof-of-concept studies employing specific modifications, including gene therapy to locally increase conduction velocity or prolong the refractory period in and around the infarct scar, and modification of scar anisotropy to improve regional mechanics and pump function. Another advantage of scar modification techniques is that they have applications well beyond MI. In particular, ablation treats electrical abnormalities of the heart by intentionally generating scar to block aberrant conduction pathways. Yet in diseases such as atrial fibrillation (AF) where ablation can be extensive, treating the electrical disorder can significantly impair mechanical function. Creating smaller, denser scars that more effectively block conduction, and choosing the location of those lesions by balancing their electrical and mechanical impacts, could significantly improve outcomes for AF patients. We review some recent advances in this area, including the use of computational models to predict the mechanical effects of specific lesion sets and gene therapy for functional ablation. Overall, emerging techniques for modifying scar properties represents a potentially important important set of tools for improving patient outcomes across a range of heart diseases, whether used in place of or as an adjunct to regenerative approaches.

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The Effect of Catheter Ablation on Left Atrial Size and Function for Patients with Atrial Fibrillation: An Updated Meta-Analysis

Cited by 34 publications

References 43 publications

Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

Combined assessment of left atrial volume parameters for predicting recurrence of atrial fibrillation following pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Making better scar: Emerging approaches for modifying mechanical and electrical properties following infarction and ablation

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