Abstract:
BACKGROUND:Identifying patients with advanced left atrial (LA) remodeling before catheter ablation (CA) of atrial fibrillation (AF) is crucial. HYPOTHESIS:This study aimed to identify echocardiographic parameters associated with changes in anatomy and conduction properties of the left atrium (LA). METHODS:We examined 75 AF patients prior to CA and measured the intervals from the P-wave-onset to four mitral annulus sites by pulsed-wave tissue Doppler imaging (PW-TDI). Patients were grouped to an upward U-pattern (delayed anterior activation) and a downward D-pattern (earliest LA activation anterior). CT-data were used to measure the LA volume (LAV). LAV was divided into anterior- (LA-A) and posterior-parts by a plane, parallel to the posterior wall and between the veins and the appendage, to calculate the asymmetry index (ASI = LA-A/LAV). RESULTS:Patients with U-pattern (n = 66) had a higher ASI (65 ± 6 vs. 61 ± 3%, p = .014), older age (61 ± 11 vs. 51 ± 11 years, p = .03) and more diastolic dysfunction (71 vs. 22%, p = .008) Multivariate regression showed that age (OR 1.1 per year, CI 1.007-1.199) and diastolic dysfunction (OR 6.36, CI 1.132-35.7, p = .036) were independent predictors of the U-pattern. Diastolic dysfunction (B 4.49, CI 1.61-7.37, p = .003) was the only independent predictor of ASI in linear regression analysis. CONCLUSION:AF patients with a U-pattern have an increased LA asymmetry. Diastolic dysfunction is a common cause of this LA activation and remodeling. Therefore, detection of a U-pattern signifies patients with advanced AF and may facilitate selection for an appropriate ablation strategy.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Nedios S,Löbe S,Knopp H,Seewöster T,Heijman J,Crijns HJGM,Arya A,Bollmann A,Hindricks G,Dinov Bdoi
10.1002/clc.23515subject
Has Abstractpub_date
2021-01-01 00:00:00pages
116-122issue
1eissn
0160-9289issn
1932-8737journal_volume
44pub_type
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