John A Dodson1, Tomas G Neilan1, Ravi V Shah1, Hoshang Farhad1, Ron Blankstein1, Michael Steigner1, Gregory F Michaud1, Roy John1, Siddique A Abbasi1, Michael Jerosch-Herold1, Raymond Y Kwong2. 1. From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA. 2. From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA. RYKwong@partners.org.
Abstract
BACKGROUND: Although pulmonary vein isolation has become a mainstream therapy for selected patients with atrial fibrillation (AF), late recurrent AF is common and its risk factors remain poorly defined. The purpose of our study was to test the hypothesis that reduced left atrial passive emptying function (LAPEF) as determined by cardiac magnetic resonance has a strong association with late recurrent AF after pulmonary vein isolation. METHODS AND RESULTS: Three hundred forty-six patients with AF referred for cardiac magnetic resonance pulmonary vein mapping before pulmonary vein isolation were included. Maximum LA volumes (VOLmax) and volumes before atrial contraction (VOLbac) were measured; LAPEF was calculated as (VOLmax-VOLbac)/VOLmax×100. Kaplan-Meier curves were constructed to determine late recurrent AF stratified by LAPEF quintile. Cox proportional hazards regression was used to adjust for known markers of recurrence. During a median follow-up of 27 months, 124 patients (35.8%) experienced late recurrent AF. Patients with recurrence were more likely to have nonparoxysmal AF (75.8% versus 51.4%; P<0.01), higher mean VOLmax (60.2 versus 52.8 mL/m(2); P<0.01), and lower mean LAPEF (19.1% versus 26.0%; P<0.01). Patients in the lowest LAPEF quintile were at highest risk of developing recurrent AF (2-year recurrence for lowest versus highest: 60.5% versus 17.3%; P<0.01). After adjusting for known predictors of recurrence, patients with low LAPEF remained significantly more likely to recur (hazard ratio for lowest versus highest quintile, 3.92; 95% confidence interval, 2.01-7.65). CONCLUSIONS: We found a strong association between LAPEF and recurrent AF after pulmonary vein isolation that persisted after multivariable adjustment.
BACKGROUND: Although pulmonary vein isolation has become a mainstream therapy for selected patients with atrial fibrillation (AF), late recurrent AF is common and its risk factors remain poorly defined. The purpose of our study was to test the hypothesis that reduced left atrial passive emptying function (LAPEF) as determined by cardiac magnetic resonance has a strong association with late recurrent AF after pulmonary vein isolation. METHODS AND RESULTS: Three hundred forty-six patients with AF referred for cardiac magnetic resonance pulmonary vein mapping before pulmonary vein isolation were included. Maximum LA volumes (VOLmax) and volumes before atrial contraction (VOLbac) were measured; LAPEF was calculated as (VOLmax-VOLbac)/VOLmax×100. Kaplan-Meier curves were constructed to determine late recurrent AF stratified by LAPEF quintile. Cox proportional hazards regression was used to adjust for known markers of recurrence. During a median follow-up of 27 months, 124 patients (35.8%) experienced late recurrent AF. Patients with recurrence were more likely to have nonparoxysmal AF (75.8% versus 51.4%; P<0.01), higher mean VOLmax (60.2 versus 52.8 mL/m(2); P<0.01), and lower mean LAPEF (19.1% versus 26.0%; P<0.01). Patients in the lowest LAPEF quintile were at highest risk of developing recurrent AF (2-year recurrence for lowest versus highest: 60.5% versus 17.3%; P<0.01). After adjusting for known predictors of recurrence, patients with low LAPEF remained significantly more likely to recur (hazard ratio for lowest versus highest quintile, 3.92; 95% confidence interval, 2.01-7.65). CONCLUSIONS: We found a strong association between LAPEF and recurrent AF after pulmonary vein isolation that persisted after multivariable adjustment.
Authors: Roberto M Lang; Michelle Bierig; Richard B Devereux; Frank A Flachskampf; Elyse Foster; Patricia A Pellikka; Michael H Picard; Mary J Roman; James Seward; Jack S Shanewise; Scott D Solomon; Kirk T Spencer; Martin St John Sutton; William J Stewart Journal: J Am Soc Echocardiogr Date: 2005-12 Impact factor: 5.251
Authors: Walter P Abhayaratna; James B Seward; Christopher P Appleton; Pamela S Douglas; Jae K Oh; A Jamil Tajik; Teresa S M Tsang Journal: J Am Coll Cardiol Date: 2006-06-20 Impact factor: 24.094
Authors: Teresa S M Tsang; Bernard J Gersh; Christopher P Appleton; A Jamil Tajik; Marion E Barnes; Kent R Bailey; Jae K Oh; Cynthia Leibson; Samantha C Montgomery; James B Seward Journal: J Am Coll Cardiol Date: 2002-11-06 Impact factor: 24.094
Authors: Yasuhiko Takemoto; Marion E Barnes; James B Seward; Steven J Lester; Christopher A Appleton; Bernard J Gersh; Kent R Bailey; Teresa S M Tsang Journal: Am J Cardiol Date: 2005-09-15 Impact factor: 2.778
Authors: Antonio Berruezo; David Tamborero; Lluis Mont; Begoña Benito; Jose María Tolosana; Marta Sitges; Bárbara Vidal; Germán Arriagada; Francisco Méndez; Maria Matiello; Irma Molina; Josep Brugada Journal: Eur Heart J Date: 2007-03-29 Impact factor: 29.983
Authors: Stefan Neubauer; Paul Kolm; Carolyn Y Ho; Raymond Y Kwong; Milind Y Desai; Sarahfaye F Dolman; Evan Appelbaum; Patrice Desvigne-Nickens; John P DiMarco; Matthias G Friedrich; Nancy Geller; Andrew R Harper; Petr Jarolim; Michael Jerosch-Herold; Dong-Yun Kim; Martin S Maron; Jeanette Schulz-Menger; Stefan K Piechnik; Kate Thomson; Cheng Zhang; Hugh Watkins; William S Weintraub; Christopher M Kramer Journal: J Am Coll Cardiol Date: 2019-11-12 Impact factor: 24.094
Authors: Mabel Toribio; Tomas G Neilan; Magid Awadalla; Lauren A Stone; Adam Rokicki; Corinne Rivard; Connor P Mulligan; Diana Cagliero; Lindsay T Fourman; Takara L Stanley; Jennifer E Ho; Virginia A Triant; Tricia H Burdo; Michael D Nelson; Lidia S Szczepaniak; Markella V Zanni Journal: J Clin Endocrinol Metab Date: 2019-12-01 Impact factor: 5.958
Authors: Larry W Markham; Jonathan H Soslow; Aryaz Sheybani; Kim Crum; Frank J Raucci; William B Burnette Journal: Pediatr Res Date: 2021-08-24 Impact factor: 3.756
Authors: Mohammadali Habibi; Sanaz Samiei; Bharath Ambale Venkatesh; Anders Opdahl; Thomas M Helle-Valle; Mytra Zareian; Andre L C Almeida; Eui-Young Choi; Colin Wu; Alvaro Alonso; Susan R Heckbert; David A Bluemke; João A C Lima Journal: Circ Cardiovasc Imaging Date: 2016-08 Impact factor: 7.792
Authors: Mayank Sardana; Adedotun A Ogunsua; Matthew Spring; Amir Shaikh; Owusu Asamoah; Glenn Stokken; Clifford Browning; Cynthia Ennis; J Kevin Donahue; Lawrence S Rosenthal; Kevin C Floyd; Gerard P Aurigemma; Nisha I Parikh; David D McManus Journal: J Cardiovasc Electrophysiol Date: 2016-10-07 Impact factor: 2.942