Predictors of the voltage derived left atrial fibrosis in patients with long-standing persistent atrial fibrillation
| Autor: | Jaroslaw Kazmierczak, Maciej Wielusiński, Andrzej Wojtarowicz, Radosław Kiedrowicz |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Population Heart Valve Diseases Catheter ablation 030204 cardiovascular system & hematology Cardioversion 03 medical and health sciences 0302 clinical medicine Internal medicine Atrial Fibrillation medicine Humans Sinus rhythm Heart Atria education Body surface area education.field_of_study Univariate analysis business.industry valvular heart disease Atrial fibrillation General Medicine Middle Aged medicine.disease Fibrosis Treatment Outcome Pulmonary Veins Cardiology Catheter Ablation Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiology journal. 29(4) |
| ISSN: | 1898-018X |
| Popis: | Background : Left atrial (LA) arrhythmogenic substrate beyond the pulmonary veins (PV) seems to play a crucial role in the maintenance of atrial fibrillation (AF). The aim of this study was to evaluate the association of selected parameters with the presence and extent of voltage-defined LA fibrosis in patients with long-standing persistent AF (LSPAF) undergoing catheter ablation. Methods: One hundred and sixteen consecutive patients underwent high density-high resolution voltage mapping of the LA with a multielectrode catheter following PV isolation and restoration of sinus rhythm with cardioversion. A non-invasive dataset, such as clinical variables, two-and three-dimensional echocardiography determined LA size and function and fibrillatory-wave amplitude on a standard surface electrocardiogram were obtained during AF before ablation. Results: Low-voltage areas (LVA; 15 cm 2 [IQR 8–31]) were detected in 56% of patients. Twenty nine percent of them presented mild, 43% moderate and 28% severe global LVA burden. In univariate analysis, age ≥ 57 years old, female sex, body surface area ≤ 1.76 m 2 , valvular heart disease, moderate mitral regurgitation, chronic coronary syndrome, hypothyroidism, CHA 2 DS 2 -VASc score ≥ 3 and ≥ 4 predicted the presence of LVA. In multivariate analysis only female sex, valvular heart disease and CHA 2 DS 2 -VASc ≥ 4 remained statistically significant. AF duration, LA size and function and fibrillatory-waves amplitude were neither associated with the prediction of the LVA, nor severe LVA burden. Conclusions: A LSPAF diagnosis does not indicate the presence of voltage defined fibrosis in many cases. Simple non-invasive screening of the LSPAF population could predict LVA prevalence. |
| Databáze: | OpenAIRE |
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