The impact of the atrial wall thickness in normal/mild late‐gadolinium enhancement areas on atrial fibrillation rotors in persistent atrial fibrillation patients

Nakamura, Toshihiro; Kiuchi, Kunihiko; Fukuzawa, Koji; Takami, Mitsuru; Watanabe, Yoshiaki; Izawa, Yu; Takemoto, Makoto; Sakai, Jun; Yatomi, Atsusuke; Sonoda, Yusuke; Takahara, Hiroyuki; Nakasone, Kazutaka; Yamamoto, K.; Suzuki, Yuya; Tani, Kazuhide; Negi, Noriyuki; Kono, Atsushi K.; Ashihara, Takashi; Hirata, Ken‐ichi

doi:10.1002/joa3.12676

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…A computer modelling study [16] demonstrated that AF drivers drifted towards and anchored to the CT/PMs and the surrounding atrial wall in the RA due to a large source-to-sink mismatch. Interestingly, a recent clinical study indicated that AWT was thinner in LA AF drivers than in non-drivers (2.1 ± 0.2 mm versus 2.23 ± 0.3 mm, p < 0.05) in moderated gadolinium-enhanced areas [17]. Notably, their clinical MRI had a relatively low spatial resolution of approximately 1.3 mm which could explain the discrepancy in the LA AWT, compared with our high-resolution MRI results (4.2 ± 1.9 mm versus 4.5 ± 1.9 mm).…”

Section: Discussionmentioning

confidence: 99%

Chamber-specific wall thickness features in human atrial fibrillation

Zhao,

Kennelly,

Nalar

et al. 2023

Interface Focus.

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Persistent atrial fibrillation (AF) is not effectively treated due to a lack of adequate tools for identifying patient-specific AF substrates. Recent studies revealed that in 30–50% of patients, persistent AF is maintained by localized drivers not only in the left atrium (LA) but also in the right atrium (RA). The chamber-specific atrial wall thickness (AWT) features underlying AF remain elusive, though the important role of AWT in AF is widely acknowledged. We aimed to provide direct evidence of the existence of distinguished RA and LA AWT features underlying AF drivers by analysing functionally and structurally mapped human hearts ex vivo . Coronary-perfused intact human atria ( n = 7, 47 ± 14 y.o.; two female) were mapped using panoramic near-infrared optical mapping during pacing-induced AF. Then the hearts were imaged at approximately 170 µm 3 resolution by 9.4 T gadolinium-enhanced MRI. The heart was segmented, and 3D AWT throughout atrial chambers was estimated and analysed. Optical mapping identified six localized RA re-entrant drivers in four hearts and four LA drivers in three hearts. All RA AF drivers were anchored to the pectinate muscle junctions with the crista terminalis or atrial walls. The four LA AF drivers were in the posterior LA. RA ( n = 4) with AF drivers were thicker with greater AWT variation than RA ( n = 3) without drivers (5.4 ± 2.6 mm versus 5.0 ± 2.4 mm, T -test p < 0.05; F -test p < 0.05). Furthermore, AWT in RA driver regions was thicker and varied more than in RA non-driver regions (5.1 ± 2.5 mm versus 4.4 ± 2.2 mm, T -test p < 0.05; F -test p < 0.05). On the other hand, LA ( n = 3) with drivers was thinner than the LA ( n = 4) without drivers. In particular, LA driver regions were thinner than the rest of LA regions (3.4 ± 1.0 mm versus 4.2 ± 1.0 mm, T -test p < 0.05). This study demonstrates chamber-specific AWT features of AF drivers. In RA, driver regions are thicker and have more variable AWT than non-driver regions. By contrast, LA drivers are thinner than non-drivers. Robust evaluation of patient-specific AWT features should be considered for chamber-specific targeted ablation.

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Section: Discussionmentioning

confidence: 99%

Chamber-specific wall thickness features in human atrial fibrillation

Zhao,

Kennelly,

Nalar

et al. 2023

Interface Focus.

View full text Add to dashboard Cite

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Distributions and number of drivers on real-time phase mapping associated with successful atrial fibrillation termination during catheter ablation for non-paroxysmal atrial fibrillation

Riku

Inden

Fujii

et al. 2023

J Interv Card Electrophysiol

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Morphometric characteristics and histotopography of the left atrium walls

Gaponov

2022

Kazan Med J

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Background. Knowledge of the anatomical features of the left atrium walls will minimize complications during the Cox-Maze surgery. Aim. To clarify common features and local anatomical specificities of the anterosuperior, lateral and inferior walls of the left atrial body of the heart of an adult. Material and methods. From 60 preparations of the hearts of men and women aged 3589 years who died from non-cardiac causes, 61 histotopograms and 180 anatomical sections of the left atrium walls were made. A stereoscopic microscope (4.715 magnification), a histological microscope (40 magnification), and an image recognition program were used. Nonparametric dispersion, correlation, one-way regression analysis were applied. The significance of differences was assessed by the MannWhitney U-test. The results were presented as medians. Results. Anatomical markers of the anterosuperior wall were a compact group of transverse myocardial fibers (anterior interatrial Bachmann bundle) and a thinned section of the lower third of the medial half of the wall. A feature of the lateral wall was a group of oblique myocardial fibers (left lateral ridge). The inferior wall was characterized by well-developed subepicardial tissue. Anteroposterior wall in the medial area (5130 m) and lateral wall (5243 m) were thin. The epicardium with subepicardial tissue in the medial part of the inferior wall was thicker (4750 m) than in the lateral (2651 m) and anterosuperior (2535 m) walls. The myocardium of the anteroposterior wall (2714 m) was thicker than the myocardium of both the lateral (2213 m) and inferior wall in its central (1947 m) and lateral (1913 m) sections. The median thickness of the endocardium of different walls varied from 335 to 426 m. The wall thickness in the upper third mostly depended primarily on the myocardium thickness, and in the inferior third on the epicardium and subepicardial tissue thickness. Conclusion. For the walls of the left atrium, their thickening towards the coronary sulcus was common due to the subepicardial adipose tissue. The peculiarities were the differences of the left atrium walls in thickness and their unique pattern of myocardial anatomy.

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The impact of the atrial wall thickness in normal/mild late‐gadolinium enhancement areas on atrial fibrillation rotors in persistent atrial fibrillation patients

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 4 publications

References 23 publications

Chamber-specific wall thickness features in human atrial fibrillation

Chamber-specific wall thickness features in human atrial fibrillation

Distributions and number of drivers on real-time phase mapping associated with successful atrial fibrillation termination during catheter ablation for non-paroxysmal atrial fibrillation

Morphometric characteristics and histotopography of the left atrium walls

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