scholarly journals Atrial Myopathy Underlying Atrial Fibrillation

2020 ◽  
Vol 9 (2) ◽  
pp. 61-70
Author(s):  
Harold Rivner ◽  
Raul D Mitrani ◽  
Jeffrey J Goldberger ◽  
◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Cardiac Mri ◽  
Vicious Cycle ◽  
Atrial Fibrosis ◽  
Plasma Biomarkers ◽  
Voltage Mapping ◽  
Assessment And Treatment ◽  
Current Therapies ◽  
Current Assessment

While AF most often occurs in the setting of atrial disease, current assessment and treatment of patients with AF does not focus on the extent of the atrial myopathy that serves as the substrate for this arrhythmia. Atrial myopathy, in particular atrial fibrosis, may initiate a vicious cycle in which atrial myopathy leads to AF, which in turn leads to a worsening myopathy. Various techniques, including ECG, plasma biomarkers, electroanatomical voltage mapping, echocardiography, and cardiac MRI, can help to identify and quantify aspects of the atrial myopathy. Current therapies, such as catheter ablation, do not directly address the underlying atrial myopathy. There is emerging research showing that by targeting this myopathy we can help decrease the occurrence and burden of AF.

scholarly journals TGFβ Is Specifically Upregulated on Circulating CD14++ CD16+ and CD14+ CD16++ Monocytes in Patients with Atrial Fibrillation and Severe Atrial Fibrosis

2018 ◽  
Vol 49 (1) ◽  
pp. 226-234 ◽  
Author(s):  
David Heinzmann ◽  
Stefan Fuß ◽  
Saskia v. Ungern-Sternberg ◽  
Jürgen Schreieck ◽  
Meinrad Gawaz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Low Voltage ◽  
Strong Increase ◽  
Atrial Remodeling ◽  
Myocardial Remodeling ◽  
Monocyte Subsets ◽  
Atrial Fibrosis ◽  
Voltage Mapping

Background/Aims: Fibrotic remodeling of the atria plays a key role in the pathogenesis of atrial fibrillation (AF). As little is known about the contribution of circulating monocytes in atrial remodeling and the pathophysiology of AF, we investigated profibrotic factors in different subsets of circulating monocytes obtained from patients with atrial fibrillation undergoing catheter ablation. Methods: A 3D high density voltage mapping was performed in sinus rhythm to evaluate the extent of low-voltage areas (LVAs) in the atria of 71 patients with persistent AF. Low-voltage was defined as signals of < 0.5mV during sinus rhythm. Prior to ablation, blood was drawn and monocytes were analyzed by FACS. Based on the expression of CD14 and CD16, three subgroups including CD14++ CD16- (‘classical’), CD14++ CD16+ (‘intermediate’), and CD14+ CD16++ (‘non-classical’) were analyzed for the expression of TGFb, CD147, and MMP-9, representing pivotal profibrotic pathways in myocardial remodeling. Results: Expression of TGFb was increased in CD14+ monocytes of patients with extensive LVAs compared to patients with a low extend of LVAs. While CD14++ CD16- monocytes showed no difference, CD14++ CD16+ and CD14+ CD16++ monocytes showed a strong increase of TGFb abundance. Although CD147 and MMP-9 are strongly associated with myocardial fibrosis, we found no difference in expression between the two groups in any monocyte subsets. Conclusion: TGFb is specifically upregulated on CD14++ CD16+ and CD14+ CD16++ monocytes in patients with extensive LVAs undergoing catheter ablation.

scholarly journals Voltage mapping as a method of left atrial fibrosis evaluation

2016 ◽  
Vol 20 (2) ◽  
pp. 111 ◽  
Author(s):  
O. V. Sapelnikov ◽  
Yu. A. Shuvalova ◽  
D. Yu. Cherkashin ◽  
A. A. Krupnov ◽  
A. S. Partigulova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Large Scale ◽  
Atrial Fibrosis ◽  
Instrumental Data ◽  
Voltage Mapping ◽  
Special Software ◽  
Mechanisms Of Development ◽  
Left Atrial Fibrosis ◽  
And Control

<p><strong>Aim:</strong> This pilot study is designed to better understand the mechanisms of development and control of atrial fibrillation.<br /><strong>Methods:</strong> The correlation between fibrosis index (FI), which was calculated intraoperatively with special software, and clinical and instrumental data was analyzed. Also evaluated were FI values as compared to AF catheter ablation outcomes. <br /><strong>Results:</strong> Voltage mapping may be considered as a possible alternative to MRI examination and in some cases it is more informative. <br /><strong>Conclusion:</strong> It was found out that the preliminary results received are a good start for planning a large-scale study in this area related to assessment of the predicative and practical value of the fibrosis index.</p>

Cardiac MRI assessment of atrial fibrosis in atrial fibrillation: implications for diagnosis and therapy

Heart ◽  
2013 ◽  
Vol 100 (7) ◽  
pp. 590-596 ◽  
Author(s):  
Koji Higuchi ◽  
Mehmet Akkaya ◽  
Nazem Akoum ◽  
Nassir F Marrouche
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Mri ◽  
Atrial Fibrosis ◽  
Diagnosis And Therapy

Catheter Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage Mapping

2020 ◽  
Vol 36 (12) ◽  
pp. 1956-1964 ◽  
Author(s):  
Pablo B. Nery ◽  
Wael Alqarawi ◽  
Girish M. Nair ◽  
Mouhannad M. Sadek ◽  
Calum J. Redpath ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Low Voltage ◽  
Persistent Atrial Fibrillation ◽  
High Density ◽  
Voltage Mapping ◽  
Procedural Outcomes

scholarly journals Left Atrial Fibrosis Assessed with Cardiac MRI in Patients with Paroxysmal and Those with Persistent Atrial Fibrillation

Radiology ◽  
2019 ◽  
Vol 292 (3) ◽  
pp. 575-582 ◽  
Author(s):  
Dong Kyu Lee ◽  
Jaemin Shim ◽  
Jong-il Choi ◽  
Young-Hoon Kim ◽  
Yu-Whan Oh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Mri ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Atrial Fibrosis ◽  
Left Atrial Fibrosis

P1375Catheter ablation of atrial fibrillation: three-dimensional transesophageal echocardiography versus magnetic resonance imaging for pulmonary vein imaging (periprocedural results and long-term follow-u

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kettering
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Image Quality ◽  
Pulmonary Vein ◽  
Cardiac Mri ◽  
Left Atrial ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
Ablation Procedure

Abstract Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, it is still challenging because of the high degree of variability of the pulmonary vein (PV) anatomy. Three-dimensional transesophageal echocardiography (TEE) is a promising new technique for cardiac imaging. Therefore, we have evaluated the usefulness of 3-D TEE for analysing the left atrial anatomy prior to an ablation procedure in comparison to magnetic resonance imaging (MRI). Methods In 120 patients, 3-D TEE and cardiac MRI were performed immediately prior to an ablation procedure (paroxysmal AF: 50 patients, persistent AF: 70 patients). The image quality provided by 3-D TEE and by cardiac MRI was compared in all patients. Two different ablation strategies were used. In patients with paroxysmal AF, the cryoablation technique was used. In the other patients, a circumferential pulmonary vein ablation was performed using a three-dimensional mapping system. Results A 3-D TEE and a cardiac MRI could be performed successfully in all patients prior to the ablation procedure. Several variations of the PV anatomy could be visualized precisely by 3-D TEE and cardiac MRI (e.g. accessory PVs, common PV ostia, varying diameter of the left atrial appendage and its distance to the left superior PV). The image quality was good in the majority of patients even if AF with rapid ventricular response was present during the examination. The image quality provided by 3-D TEE was acceptable in 116/120 patients (96.7 %). The TEE findings correlated well with the PV angiographies performed using cardiac MRI. There was a good correlation with regard to the diameter of the PV ostia assessed by these two imaging techniques. All ablation procedures could be performed successfully (mean number of completely isolated PVs: 3.9  (cryo group), 4.0 (radiofrequency catheter ablation group)). At 42-month follow-up, 70.0 % of all patients were free from an arrhythmia recurrence (cryo group: 76.0 %, Carto group: 65.7 %). There were no major complications. Conclusions AF ablation procedures can be performed safely and effectively based on prior 3-D TEE imaging. The image quality was acceptable in the vast majority of patients.

P5657Fibrosis detected by late-gadolinium enhancement cardiac MRI is associated with atrial fibrillation and poorer ablation outcome: A meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T A Agbaedeng ◽  
M Emami ◽  
D A Munawar ◽  
T Rattanakosit ◽  
K I Khadim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Late Gadolinium Enhancement ◽  
Catheter Ablation ◽  
Cardiac Mri ◽  
Meta Analysis ◽  
Ventricular Wall ◽  
Gadolinium Enhancement ◽  
Increased Risk ◽  
Lge Cmr ◽  
Af Recurrence

Abstract Background Fibrosis is a hallmark of atrial fibrillation (AF) substrate. Recent data suggests that fibrosis detected by late-gadolinium enhancement (LGE) cardiac MRI (CMR) can predict AF. However, this relationship is not well described. Objective To delineate the association of cardiac fibrosis detected by LGE CMR with AF prevalence, AF recurrence after catheter ablation. Methods PubMed, Embase, Web of Science and Ovid MEDLINE were searched through November 2018, using the keywords: LGE AND Fibrosis AND CMR AND AF. Inclusion criteria: 1. LGE CMR of left atrial (LA LGE), ventricular wall (LV LGE) or right ventricular wall (RV LGE); 2. Studies reporting AF or recurrent arrhythmia after ablation; 3. Patient ≥18 years; and 4. ≥50 participants. Included studies were pooled in a random effects meta-analysis and reported as: mean difference (MD); unadjusted risk ratios (RR); adjusted hazard ratios (HR); and 95% confidence intervals (95% CI). Results After exclusions, we identified 9 studies (2,307 patients [65.9% males, 34.1% females]) conducted between 2003 and 2015 for LGE and AF. Fibrosis was present in 666 (35.1%) and detected by LV LGE in 7 (78%) and RV LGE in 2 (22%). The presence of AF was higher in patients positive for ventricular LGE than those negative, trending towards significance (RR: 1.51, 95% CI: 0.94–2.45, p=0.09). Pooled LV fibrosis associated with AF progression (RR [NPAF vs. PAF]: 2.2, 95% CI: 1.22–3.94, p=0.009). We identified 8 studies (2,041 patients [65.8% males, 34.2% females]) conducted between 2006 and 2016 reporting LGE and AF recurrence after catheter ablation, with fibrosis detected in 644 (31.6%) by LA LGE in 8 (88.9%, biased towards one centre). After 17.8±14.2 follow-up years, atrial fibrosis was significantly greater in recurrent AF than controls (MD: 4.97%, 95% CI: 1.23–8.7, p<0.01), and predicted 16% increased risk of AF recurrence (RR: 1.16, 95% CI: 1.07–1.26, p<0.05). Conclusion Myocardial fibrosis detected by LGE associates with prevalence and progress of AF and is predictive of AF recurrence post ablation. This further supports the proarrhythmic role of fibrosis and selection of patients for ablation therapy based on LGE.

Diffuse Ventricular Fibrosis Measured by T 1 Mapping on Cardiac MRI Predicts Success of Catheter Ablation for Atrial Fibrillation

2014 ◽  
Vol 7 (5) ◽  
pp. 834-840 ◽  
Author(s):  
Alex J.A. McLellan ◽  
Liang-han Ling ◽  
Sonia Azzopardi ◽  
Andris H. Ellims ◽  
Leah M. Iles ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Cardiac Mri ◽  
Ventricular Fibrosis

scholarly journals Role of serum TGF-β1 level in atrial fibrosis and outcome after catheter ablation for paroxysmal atrial fibrillation

Medicine ◽  
2017 ◽  
Vol 96 (51) ◽  
pp. e9210 ◽  
Author(s):  
Ye Tian ◽  
Yubin Wang ◽  
Weijie Chen ◽  
Yuehui Yin ◽  
Mu Qin
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Paroxysmal Atrial Fibrillation ◽  
Atrial Fibrosis ◽  
Tgf Β1
Sign in / Sign up

Export Citation Format

Share Document