INTRODUCTION: Atrial fibrillation (AF) is associated with electroanatomical remodelling of the left atrium (LA), especially with LA dilatation. However, little is known about the changes of the three-dimensional structure of the LA, regarding the type of atrial fibrillation and their prognostic value after an ablative treatment. METHODS:One hundred fifteen patients (72 males, 59 ± 11 years) with an indication for AF ablation were prospectively included. Preoperatively, all patients underwent cardiac computed tomography (CCT). A reconstruction of the LA and the pulmonary veins (PV) was made from CCT data using specialized software (EP PreNavigator, Philips, The Netherlands). Left atrial volume (LAV) after exclusion of the atrial appendage (LAA) and the PV was determined. The LA was then arbitrarily divided by a cutting plane, between the anterior segment of the PV ostia and the atrial appendage and parallel to the posterior wall, to anterior-(LA-Ant.) and posterior-LA (LA-Post.). The ratio LA-Ant./LAV was defined as asymmetry index (ASI). The cardiac CT data, of 25 patients (11 women, 47 ± 11 years) without organic heart disease, were similarly studied for the same parameters, as a control group. RESULTS:Patients with paroxysmal AF (n = 63) had significantly higher LAV (131 ± 31 vs. 95 ± 18 ml, p < 0.001) and higher ASI (61 ± 6 % vs. 57 ± 4, p = 0.002) than the control group. Patients with persistent AF (n = 34) in comparison with paroxysmal AF showed significantly larger volumes (154 ± 44 vs. 131 ± 31 ml, p = 0.007) but no difference in the ASI (60 ± 8% vs. 61 ± 6%, p = 0.63). Finally, patients with long-term persistent AF (n = 18) showed a bigger asymmetry index than the patients with persistent AF (64 ± 5% vs. 60 ± 8%, p = 0.06) but no significant difference in volumes (161 ± 21 vs. 154 ± 44 ml, p = 0.49). LAA and partial LA volumes had a dilatation pattern similar to LAV. During a follow-up of over 25 ± 7 months, AF recurred in 31 (27%) patients. Multivariate analysis showed that ASI and LAV were the only two significant predictors of AF recurrence after ablative treatment. Independent of LAV, an ASI over 60% predicted AF recurrence with 74% sensitivity and 73% specificity. CONCLUSION: Characteristic differences of both left atrial volume and geometry exist between the different forms of atrial fibrillation (paroxysmal, persistent and long-term persistent). The asymmetry index is a simple parameter derived by cardiac CT data that reflects these changes of LA geometry and predicts the outcome after the pulmonary vein isolation.
RCT Entities:
INTRODUCTION:Atrial fibrillation (AF) is associated with electroanatomical remodelling of the left atrium (LA), especially with LA dilatation. However, little is known about the changes of the three-dimensional structure of the LA, regarding the type of atrial fibrillation and their prognostic value after an ablative treatment. METHODS: One hundred fifteen patients (72 males, 59 ± 11 years) with an indication for AF ablation were prospectively included. Preoperatively, all patients underwent cardiac computed tomography (CCT). A reconstruction of the LA and the pulmonary veins (PV) was made from CCT data using specialized software (EP PreNavigator, Philips, The Netherlands). Left atrial volume (LAV) after exclusion of the atrial appendage (LAA) and the PV was determined. The LA was then arbitrarily divided by a cutting plane, between the anterior segment of the PV ostia and the atrial appendage and parallel to the posterior wall, to anterior-(LA-Ant.) and posterior-LA (LA-Post.). The ratio LA-Ant./LAV was defined as asymmetry index (ASI). The cardiac CT data, of 25 patients (11 women, 47 ± 11 years) without organic heart disease, were similarly studied for the same parameters, as a control group. RESULTS:Patients with paroxysmal AF (n = 63) had significantly higher LAV (131 ± 31 vs. 95 ± 18 ml, p < 0.001) and higher ASI (61 ± 6 % vs. 57 ± 4, p = 0.002) than the control group. Patients with persistent AF (n = 34) in comparison with paroxysmal AF showed significantly larger volumes (154 ± 44 vs. 131 ± 31 ml, p = 0.007) but no difference in the ASI (60 ± 8% vs. 61 ± 6%, p = 0.63). Finally, patients with long-term persistent AF (n = 18) showed a bigger asymmetry index than the patients with persistent AF (64 ± 5% vs. 60 ± 8%, p = 0.06) but no significant difference in volumes (161 ± 21 vs. 154 ± 44 ml, p = 0.49). LAA and partial LA volumes had a dilatation pattern similar to LAV. During a follow-up of over 25 ± 7 months, AF recurred in 31 (27%) patients. Multivariate analysis showed that ASI and LAV were the only two significant predictors of AF recurrence after ablative treatment. Independent of LAV, an ASI over 60% predicted AF recurrence with 74% sensitivity and 73% specificity. CONCLUSION: Characteristic differences of both left atrial volume and geometry exist between the different forms of atrial fibrillation (paroxysmal, persistent and long-term persistent). The asymmetry index is a simple parameter derived by cardiac CT data that reflects these changes of LA geometry and predicts the outcome after the pulmonary vein isolation.
Authors: Michel Haïssaguerre; Prashanthan Sanders; Mélèze Hocini; Yoshihide Takahashi; Martin Rotter; Frederic Sacher; Thomas Rostock; Li-Fern Hsu; Pierre Bordachar; Sylvain Reuter; Raymond Roudaut; Jacques Clémenty; Pierre Jaïs Journal: J Cardiovasc Electrophysiol Date: 2005-11
Authors: Jannie Ausma; Huub M W van der Velden; Marie-Hélène Lenders; Erwin P van Ankeren; Habo J Jongsma; Frans C S Ramaekers; Marcel Borgers; Maurits A Allessie Journal: Circulation Date: 2003-04-07 Impact factor: 29.690
Authors: A J Sanfilippo; V M Abascal; M Sheehan; L B Oertel; P Harrigan; R A Hughes; A E Weyman Journal: Circulation Date: 1990-09 Impact factor: 29.690
Authors: N A Mark Estes; Jonathan L Halperin; Hugh Calkins; Michael D Ezekowitz; Paul Gitman; Alan S Go; Robert L McNamara; Joseph V Messer; James L Ritchie; Sam J W Romeo; Albert L Waldo; D George Wyse Journal: Circulation Date: 2008-02-18 Impact factor: 29.690
Authors: Krit Jongnarangsin; Aman Chugh; Eric Good; Siddharth Mukerji; Sujoya Dey; Thomas Crawford; Jean F Sarrazin; Michael Kuhne; Nagib Chalfoun; Darryl Wells; Warangkna Boonyapisit; Frank Pelosi; Frank Bogun; Fred Morady; Hakan Oral Journal: J Cardiovasc Electrophysiol Date: 2008-03-21
Authors: Sakis Themistoclakis; Robert A Schweikert; Walid I Saliba; Aldo Bonso; Antonio Rossillo; Giovanni Bader; Oussama Wazni; David J Burkhardt; Antonio Raviele; Andrea Natale Journal: Heart Rhythm Date: 2008-01-30 Impact factor: 6.343
Authors: Martin Schmidt; F Straube; U Ebersberger; U Dorwarth; M Wankerl; J Krieg; E Hoffmann Journal: Herzschrittmacherther Elektrophysiol Date: 2012-12-05
Authors: Andreas Goette; Jonathan M Kalman; Luis Aguinaga; Joseph Akar; Jose Angel Cabrera; Shih Ann Chen; Sumeet S Chugh; Domenico Corradi; Andre D'Avila; Dobromir Dobrev; Guilherme Fenelon; Mario Gonzalez; Stephane N Hatem; Robert Helm; Gerhard Hindricks; Siew Yen Ho; Brian Hoit; Jose Jalife; Young-Hoon Kim; Gregory Y H Lip; Chang-Sheng Ma; Gregory M Marcus; Katherine Murray; Akihiko Nogami; Prashanthan Sanders; William Uribe; David R Van Wagoner; Stanley Nattel Journal: Heart Rhythm Date: 2016-06-10 Impact factor: 6.343
Authors: Maryam E Rettmann; Mia S Gunawan; David R Holmes; Jerome F Breen; Douglas L Packer; Richard A Robb Journal: Acad Radiol Date: 2012-08-11 Impact factor: 3.173
Authors: Sotirios Nedios; Frank Lindemann; Jordi Heijman; Harry J G M Crijns; Andreas Bollmann; Gerhard Hindricks Journal: Herz Date: 2021-07-05 Impact factor: 1.443
Authors: Joshua Cates; Erik Bieging; Alan Morris; Gregory Gardner; Nazem Akoum; Eugene Kholmovski; Nassir Marrouche; Christopher McGann; Rob S MacLeod Journal: Clin Med Insights Cardiol Date: 2015-08-26