Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial fibrillation.

Autor: Williams SE; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., O'Neill L; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Roney CH; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Julia J; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Metzner A; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany., Reißmann B; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany., Mukherjee RK; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Sim I; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Whitaker J; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Wright M; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Niederer S; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom., Sohns C; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.; Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany., O'Neill M; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2019 Sep; Vol. 30 (9), pp. 1416-1427. Date of Electronic Publication: 2019 Jun 18.
DOI: 10.1111/jce.13990
Abstrakt: Background: The multiple wavelets and functional re-entry hypotheses are mechanistic theories to explain atrial fibrillation (AF). If valid, a chamber's ability to support AF should depend upon the left atrial size, conduction velocity (CV), and refractoriness. Measurement of these parameters could provide a new therapeutic target for AF. We investigated the relationship between left atrial effective conducting size (LA ECS ), a function of area, CV and refractoriness, and AF vulnerability in patients undergoing AF ablation.
Methods and Results: Activation mapping was performed in patients with paroxysmal (n = 21) and persistent AF (n = 18) undergoing pulmonary vein isolation. Parameters used for calculating LA ECS were: (a) left atrial body area (A); (b) effective refractory period (ERP); and (c) total activation time (T). Global CV was estimated as √ A / T . Effective atrial conducting size was calculated as LA ECS = A / ( CV × ERP ) . Post ablation, AF inducibility testing was performed. The critical LA ECS required for multiple wavelet termination was determined from computational modeling. LA ECS was greater in patients with persistent vs paroxysmal AF (4.4 ± 2.0 cm vs 3.2 ± 1.4 cm; P = .049). AF was inducible in 14/39 patients. LA ECS was greater in AF-inducible patients (4.4 ± 1.8 cm vs 3.3 ± 1.7 cm; P = .035, respectively). The difference in LA ECS between inducible and noninducible patients was significant in patients with persistent (P = .0046) but not paroxysmal AF (P = .6359). Computational modeling confirmed that LA ECS  > 4 cm was required for continuation of AF.
Conclusions: LA ECS measured post ablation was associated with AF inducibility in patients with persistent, but not paroxysmal AF. These data support a role for this method in electrical substrate assessment in AF patients.
(© 2019 The Authors Journal of Cardiovascular ElectrophysiologyPublished by Wiley Periodicals, Inc.)
Databáze: MEDLINE
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