Anatomical and electrophysiological factors involved in atrial cardiomyopathy identify remodeling discrepancies between paroxysmal and persistent atrial fibrillation
| Autor: | T Huang, D N Nairn, T A Arentz, A J Jadidi |
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| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Europace. 25 |
| ISSN: | 1532-2092 1099-5129 |
| Popis: | Funding Acknowledgements Type of funding sources: None. Background Progressive atrial fibrotic remodeling has been reported to be associated with atrial cardiomyopathy and the transition from paroxysmal to persistent atrial fibrillation(AF). We sought to identify the anatomical and electrophysiological factors involved in atrial remodeling that promote AF persistency. Methods Consecutive patients with paroxysmal(n=134) or persistent(n=136) AF who presented for their first AF ablation procedure were included. Patients underwent high-definition mapping (1835 ± 421 sites/map) during sinus rhythm and were randomized to training and validation sets for model development and evaluation. A total of 62 parameters from both electro-anatomical left atrial(LA) mapping and non-invasive baseline data were extracted encompassing four main categories: (1)LA size, (2)extent of low-voltage-substrate(LVS), (3)LA voltages and (4)bi-atrial conduction time as identified by the duration of amplified P-wave(APWD) in a digital 12-lead-ECG. Least absolute shrinkage and selection operator(LASSO) and logistic regression were performed to identify the factors that are most relevant to AF persistency in each category alone and all categories combined. The performance of the developed models for diagnosis of AF persistency was validated regarding discrimination, calibration and clinical usefulness. Results In training and validation sets, APWD (threshold 151ms), LA volume (threshold 94ml), bipolar LVS area Conclusion Among 62 electro-anatomical parameters, we identified APWD, LA volume, LVS extent and mean LA voltage as the four determinant electrophysiological and anatomical factors that are most indicative for AF persistency. Notably, the combination of APWD with LA volume enabled discrimination between paroxysmal and persistent AF with high accuracy, emphasizing their importance as underlying substrate of persistent AF. |
| Databáze: | OpenAIRE |
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