Abstract:

Introduction: prevalence of atrial fibrillation (AF) in the population continues to rise steadily due to the rapid aging of the population [1]. The search for the morphological substrate of AF has been going on for more than half a century. Left atrial remodeling has become such an important aspect in the pathogenesis of AF that some authors advocate the definition of atrial cardiomyopathies [3].

Aim: was to examine the impact of various imaging techniques on the detection of atrial fibrosis and their key role in the treatment of atrial fibrillation.

Conclusions: currently, radiological imaging techniques are available for clinical practice and provide additional possibilities in the assessment of left anterior segment function in AF. Morpho-functional changes in the left atrium can have a great impact on the global hemodynamic function of the left atrium, and as a consequence, these changes can be a significant predictor of the risk of AF progression and stroke development. Morpho-functional changes in the left atrium can have a great impact on the global hemodynamic function of the left atrium, and as a consequence, these changes can be a significant predictor of the risk of AF progression and stroke development.

Abstract:

Introduction: left atrial (LA) volumes measured during different phases of the cardiac cycle can be used for the evaluation of the LA functional properties before and after catheter ablation (CA). Increase of LA ejection fraction (EF) supposed to be early and more sensitive marker of LA reverse remodeling process, than LA volume and can be important for assessing the effectiveness of CA.

Aim: was to estimate volumetric parameters and function of LV before and after cryo- and radiofrequency catheter ablation of pulmonary veins in patients with paroxysmal atrial fibrillation.

Materials and methods: 21 patients with paroxysmal atrial fibrillation (AF) were included in study. All patients underwent multidetector computed tomography (MDCT) of pulmonary veins (PV) and LA before CA and 12±2 months after CA. 3-dimensional images at phases 0%, 40%, 75% of the cardiac cycle were used to assess LA functional properties.

Results: LA maximal volume before CA was increased insignificantly in patients with AF recurrence (124,52±38,22 ml vs. 117,89±23,94 ml, p>0,05). In patients without recurrence after CA, LA volumes decreased slightly (LA max 115,31±20,13 ml, p>0,05, LA min 73,43±14,91 ml, p>0,05), while in patients with recurrence increased (LA max 130,88±25,20 ml, p<0,05, LA min to 94,92±31,75 ml, p<0,05). Global LA ejection fraction was less in patients without recurrence before CA (22,37%±4,69 vs. 31,31%±9,89, p=0,013), but increased significantly after CA, while in patients with recurrence global LA EF was without relevant changes (36,54%±3,27 vs. 28,89%±9,41, p=0,011).

Conclusion: improved left atrial mechanical function was demonstrated in patients without any recurrence after ablation. The anatomic and functional reverse remodeling was not significant in patients with atrial fibrillation recurrence.

References

1.     Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021; 16(2): 217-221.

https://doi.org/10.1177/1747493019897870

2.     Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021; 42(5): 373-498.

https://doi.org/10.1093/eurheartj/ehaa612

3.     Hindricks G, Sepehri Shamloo A, Lenarczyk R, et al. Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challenges. Kardiol Pol. 2018; 76(12): 1680-1686.

https://doi.org/10.5603/KP.a2018.0216

4.     Artjuhina EA, Revishvili ASh. New technologies in the treatment of cardiac arrhythmias. Vysokotehnologichnaja medicina. 2017; 1: 7-15 [In Russ].

5.     Darby AE. Recurrent Atrial Fibrillation After Catheter Ablation: Considerations For Repeat Ablation And Strategies To Optimize Success. J Atr Fibrillation. 2016; 9(1): 1427.

https://doi.org/10.4022/jafib.1427

6.     Murray MI, Arnold A, Younis M, et al. Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials. Clin Res Cardiol. 2018; 107(8): 658-669.

https://doi.org/10.1007/s00392-018-1232-4

7.     Kuck KH, Brugada J, F?rnkranz A, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016; 374(23): 2235-2245.

https://doi.org/10.1056/NEJMoa1602014

8.     Mathew ST, Patel J, Joseph S, et al. Atrial fibrillation: mechanistic insights and treatment options. Eur J Intern Med. 2009; 20(7): 672-81.

https://doi.org/10.1016/j.ejim.2009.07.011

9.     Vasamreddy CR, Lickfett L, Jayam VK, et al. Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter. J Cardiovasc Electrophysiol. 2004; 15(6): 692-697.

https://doi.org/10.1046/j.1540-8167.2004.03538.x

10.   Tops LF, Bax JJ, Zeppenfeld K, et al. Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size. Am J Cardiol. 2006; 97(8): 1220-1222.

https://doi.org/10.1016/j.amjcard.2005.11.043

11.   Tsao HM, Hu WC, Wu MH, et al. The impact of catheter ablation on the dynamic function of the left atrium in patients with atrial fibrillation: insights from four-dimensional computed tomographic images. J Cardiovasc Electrophysiol. 2010; 21(3): 270-277.

https://doi.org/10.1111/j.1540-8167.2009.01618.x

12.   Abhayaratna WP, Seward JB, Appleton CP, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006; 47(12): 2357-2363.

https://doi.org/10.1016/j.jacc.2006.02.048

13.   Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014; 63(6): 493-505.

https://doi.org/10.1016/j.jacc.2013.10.055

14.   Costa FM, Ferreira AM, Oliveira S, et al. Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation. Int J Cardiol. 2015; 184: 56-61.

https://doi.org/10.1016/j.ijcard.2015.01.060

15.   Avelar E, Durst R, Rosito GA, et al. Comparison of the accuracy of multidetector computed tomography versus two-dimensional echocardiography to measureleft atrial volume. Am J Cardiol. 2010; 106(1): 104-109.

https://doi.org/10.1016/j.amjcard.2010.02.021

16.   K?hl JT, L?nborg J, Fuchs A, et al. Assessment of left atrial volume and function: a comparative study between echocardiography, magnetic resonance imaging and multi slice computed tomography. Int J Cardiovasc Imaging. 2012; 28(5): 1061-1071.

https://doi.org/10.1007/s10554-011-9930-2

17.   Hof I, Chilukuri K, Arbab-Zadeh A, et al. Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation? J Cardiovasc Electrophysiol. 2009; 20(9): 1005-1010.

https://doi.org/10.1111/j.1540-8167.2009.01504.x

18.   Abecasis J, Dourado R, Ferreira A, et al. Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation. Europace. 2009; 11(10): 1289-1294.

https://doi.org/10.1093/europace/eup198

19.   Amin V, Finkel J, Halpern E, et al. Impact of left atrial volume on outcomes of pulmonary vein isolation in patients with non-paroxysmal (persistent) and paroxysmal atrial fibrillation. Am J Cardiol. 2013; 112(7): 966-970.

https://doi.org/10.1016/j.amjcard.2013.05.034

20.   Lemola K, Sneider M, Desjardins B, et al. Effects of left atrial ablation of atrial fibrillation on size of the left atrium and pulmonary veins. Heart Rhythm. 2004; 1(5): 576-581.

https://doi.org/10.1016/j.hrthm.2004.07.020

21.   Park MJ, Jung JI, Oh YS, et al. Assessment of the structural remodeling of the left atrium by 64-multislice cardiac CT: comparative studies in controls and patients with atrial fibrillation. Int J Cardiol. 2012; 159(3): 181-186.

https://doi.org/10.1016/j.ijcard.2011.02.053

22.   Lemola K, Desjardins B, Sneider M, et al. Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function. Heart Rhythm. 2005; 2(9): 923-928.

https://doi.org/10.1016/j.hrthm.2005.06.026

23.   Perea RJ, Tamborero D, Mont L, et al. Left atrial contractility is preserved after successful circumferential pulmonary vein ablation in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2008; 19(4): 374-379.

https://doi.org/10.1111/j.1540-8167.2007.01086.x 

Abstract:

Aim: to study the contractility of left ventricle (LV) and left atrium (LA) by speckle tracking imaging (STI), vector analysis and the diagram method in patients with mitral regurgitation (MR).

Materials and methods: we examined 63 patients (39 males, 24 females), mean age 53±11 years with 3-4 degree MR and control group of 26 healthy volunteers (15 males, 11 females), mean age 39±7 years. Transthoracic echocardiography was performed by a standard technique at rest. Sizes and volumes of LV, LA, ejection fraction (EF), degree of MR, pulmonary artery (PA) pressure were evaluated. LV and LA images were analyzed by STI with LV global longitudinal strain (GS), peak atrial longitudinal (PALS) and contraction strain (PACS), and by vector analysis of myocardial displacement and «Flow-Volume» diagrams. Rates of volume change in LV (dVol/dt) and LA (LAdVol/dt), rates of long axis change in LV (dLA/dt) and LA (LAdLA/dt), LA long axis size (LA) were calculated in systole (reservoir phase) and diastole (conduit phase). Statistical analysis (Statistica,10.0; JMP).

Results: left heart sizes and volumes, PA pressure compared to the norm were increased(p<0,(0)), but the EF was preserved. GS and PACS in patients with MR was normal, but PALS was reduced (p<0,(0)), while dVol/dt and LAdVol/dt were increased and shown in «Flow-Volume» diagrams. But, dLA/dt was normal, LAdLA/dt was reduced in the conduit phase, LA size was increased (p<0,(0)).

Conclusion: STI, vector analysis and diagram method parameters are the criteria for efficiency of LV and LA function in patients with MR.

References

1.      Nishimura R. A., Otto C. M., Bonow R. O., et.al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2017; 135: e1159-e1195.

2.      Voigt, J.U., Pedrizzetti G. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J.U. Voigt, G. Pedrizzetti, P. Lysyansky [et al.] Eur. Heart J. Cardiovasc. Imaging. 2015; 16 (1): 1-11.

3.      Kalinin A., Alekhin M. N., Bakhs G. idr. Otsenka deformatsii levogo predserdiya u bolnyh arterialnoy gipertoniey i aortalnym stenozom s razlichnoy stepenyu gipertrofii levogo zheludochka [Left atrial deformation assessment in patients with arterial hypertension and aortic stenosis with varying degrees of left ventricle hypertrophy]. Ter. arhiv. 2012; 4: 23-29 [In Russ].

4.      Pavlyukova E.N., Kuzhel D.A., Matyushin G.V. Funktsiya levogo predserdiya: sovremennye metody otsenki i klinicheskoe znachenie [Left atrial function: new assessment methods and clinical significance]. Ratsionalnayafarmakoterapiya v kardiologii. 20l7;13(5):675-683 [ In Russ].

5.      Sokhibnazarova V.H.,Saidova M.A., Tereschenko S.N. Primenenie novykh ekhokardiograficheskikh tehnologiy nedopplerovskogo izobrazheniyamiokarda v dvumernom i trekhmernom rezhimakh u bolnykh KHSN s sokhrannoy i snizhennoy frakciey vybrosa levogo zheludochka [Application of new echocardiographic technologies of non-doppler myocardial images in 2D and 3D modes in patients with chronic heart failure with preserved and reduced ejection fraction]. Evraziyskiy kardiologicheskiy zhurnal. 2017; 2: 42-47 [In Russ].

6.      Cameli M., Incampo E., Mondillo S., Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation, IJC Heart&Vasculature. 2017; 17: 17-22.

7.      Sandrikov V.A., Kulagina T. Yu., Ivanov V.A. i soavt. Fenomenologicheskie zakonomernosti v otsenke funkcii levogo zheludochka serdca pri nedostatochnosti mitralnogo klapana [Phenomenological regularities in left ventricle function assessment at mitral valve insufficiency]. Zh. Kardiologija. 2018; 58(1): 32-40 [In Russ].

8.      Pathan F., Elia N., Nolan M.T., et.al. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J. Am Soc. Echocar- diogr. 2017;30(1): 59-70.

9.      Leischik R., Littwitz H., Dworrak B. Echocardiographic Evaluation of Left Atrial Mechanics: Function, History, Novel Techniques, Advantages, andPitfalls. 2015; 1-8.

10.    Debonnaire P, Leong D. P, Witkowski T. G. et al.Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. Journal of the American Society of Echocardiography. 2013.26 (9): 1053-1062.