Reversal of spherical remodelling of the left atrium after pulmonary vein isolation: incidence and predictors.

Autor:	Bisbal F; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Guiu E; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Cabanas P; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain., Calvo N; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain., Berruezo A; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Tolosana JM; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Arbelo E; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Vidal B; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., de Caralt TM; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Sitges M; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Brugada J; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain., Mont L; Unitat de Fibril·lació Auricular (UFA), Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain lmont@clinic.ub.es.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2014 Jun; Vol. 16 (6), pp. 840-7. Date of Electronic Publication: 2014 Jan 02.
DOI:	10.1093/europace/eut385
Abstrakt:	Aims: Pulmonary vein isolation (PVI) induces left atrial (LA) volume reduction, known as reverse remodelling (RR). The related changes in LA shape have not yet been evaluated. Left atrial sphericity (LASP) is a new shape-based marker of remodelling that compares LA geometry and a perfect sphere and is a powerful predictor of PVI success. We aimed to evaluate the effect of PVI on LASP and describe the concept of spherical and volumetric RR. Methods and Results: Left atrial sphericity and volume were automatically obtained with self-customized software using a magnetic resonance imaging-based three-dimensional reconstruction of LA. Reverse remodelling was defined as improvement in LASP (spherical RR) or volume reduction (volumetric RR). In a series of 102 patients, spherical and volumetric RR was observed in 42.2 and 69%, respectively. Patients with paroxysmal atrial fibrillation (AF) had higher probability to present spherical RR as compared with patients with persistent AF (50.8 vs. 29.3%, P = 0.03). Patients with persistent AF showed significant post-procedural worsening of LASP (81.9 vs. 82.9%, P = 0.04). Patients with no recurrence showed a trend towards a higher proportion of spherical RR compared with those with recurrences (46.2 vs. 32.4%, respectively); no differences were observed in volumetric RR (62.1 vs. 62.9%, respectively). Paroxysmal AF was the only independent predictor of spherical RR. Conclusion: Pulmonary vein isolation leads to spherical RR in a substantial proportion of patients, and in higher proportion of patients with paroxysmal AF. Reverse remodelling may be caused by a combination of scarring and myocardial structural recovery. Changes in LASP might be more specific than volume reduction to detect favourable remodelling. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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