Echocardiographic Biatrial Remodelling and Diastolic Function Assessment in Long-Term Follow-Up after Typical Atrial Flutter Ablation
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Abstract
Background: A reverse left atrial (LA) remodelling after atrial fibrillation (AF) ablation has been reported and a relationship between diastolic function and AF is well known. However, there is little information about atrial remodelling and diastolic function after cavotricuspid isthmus (CTI) ablation. We aimed to evaluate long-term biatrial remodelling and diastolic function in patients undergoing CTI ablation.
Methods: A transthoracic echocardiography was performed at baseline and at long-term follow-up (6.3 ± 0.5 years) in a total of 39 patients who underwent AFl ablation. Right atrial end diastolic areas (RAEDA) and end systolic areas (RAESA), right atrial contraction fraction (RACF), mitral A wave velocity, E/A rate and LA diameter were measured. They were compared using the Wilcoxon rank sum test.
Results: Mean (SD) age was 64 (10) years, 82% male, 49% hypertension and 44% prior AF episodes. Basal RAEDA and RAESA were higher than at follow-up: median (IQR) of 24.6 cm2 (19.8-28.2) vs. 20.0 cm2 (16.0-25.0), p = 0.017 and 17.4 cm2 (13.0-19.3) vs. 12.0 cm2 (9.8-17.0), p = 0.001, respectively. RACF was higher at follow-up: 0.41 (0.35-0.45) vs. 0.31 (0.19-0.37), p = 0.001. Basal mitral A wave velocity was lower than at follow-up: 0.51 (0.4-0.6) vs. 0.78 (0.7-0.9), p =0.001 and E/A rate was higher 1.9 (1.2-3.1) vs. 0.9 (0.7-1.1), p = 0.001. LA diameter at baseline was 44.8 mm (39.3-50.7) vs. 46 mm (41.5-51.5) at follow-up, p <0.001.
Conclusion: AFl ablation led to reverse remodelling of the right atrium and improved diastolic dysfunction parameters in the long-term follow-up.
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Copyright (c) 2014 Cabanas-Grandío P, et al.
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Vasan RS, Larson MG, Levy D, Galderisi M, Wolf PA, et al. (2003) Doppler transmitral flow indexes and risk of atrial fibrillation (the Framingham Heart Study). Am J Cardiol 91: 1079-1083.
Thomas L, McKay T, Byth K, Marwick TH (2007) Abnormalities of left atrial function after cardioversion: An atrial strain rate study. Heart93: 89-95.
Khan IA (2002) Transient atrial mechanical dysfunction (stunning) after cardioversion of atrial fibrillation and flutter. Am Heart Journal144: 11-22.
Thomas L (2003) Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation. Eur Heart J 24: 1942-1951.
Kuppahally SS, Akoum N, Badger TJ, Burgon NS, Haslam T, et al. (2010) Echocardiographic left atrial reverse remodeling after catheter ablation of atrial fibrillation is predicted by preablation delayed enhancement of left atrium by magnetic resonance imaging. Am Heart J 160: 877-884.
Waldo AL, Feld GK (2008) Inter-relationships of atrial fibrillation and atrial flutter mechanisms and clinical implications. J Am Coll Cardiol 51: 779-786.
Sparks PB, Jayaprakash S, Vohra JK, Mond HG, Yapanis AG, et al. (1998) Left atrial "stunning" following radiofrequency catheter ablation of chronic atrial flutter. J Am Coll Cardiol 32: 468-475.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, et al. (2005) Recommendations for chamber quantification: A report from the american society of echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the european association of echocardiography, a branch of the european society of cardiology. J Am Soc Echocardiogr 18: 1440-1463.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, et al. (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7: 79-108.
Smith MD “Left ventricular diastolic function. Clinical utility of doppler echocardiography”. In: Otto catherine. The practice of clinical echocardiography. 2ª edition. Philadelphia. WB Saunders Company. 2002: 46-54.
Beukema WP, Elvan A, Sie HT, Misier AR, Wellens HJ (2005) Successful radiofrequency ablation in patients with previous atrial fibrillation results in a significant decrease in left atrial size. Circulation 112: 2089-2095.
Reant P, Lafitte S, Jais P, Serri K, Weerasooriya, et al. (2005) Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation. Circulation 112: 2896-2903.
Jahnke C, Fischer J, Gerds-Li J-H, Gebker R, Manka R, et al. (2011) Serial monitoring of reverse left-atrial remodeling after pulmonary vein isolation in patients with atrial fibrillation: A magnetic resonance imaging study. Int J Cardiol153: 42-46.
Montserrat S, Sitges M, Calvo N, Silva E, Tamborero D, et al. (2011) Effect of repeated radiofrequency catheter ablation on left atrial function for the treatment of atrial fibrillation. Am J Cardiol 108: 1741-1746.
Richter B, Gwechenberger M, Socas A, Zorn G, Albinni S, et al. (2011) Time course of markers of tissue repair after ablation of atrial fibrillation and their relation to left atrial structural changes and clinical ablation outcome. Int J Cardiol 152: 231-236.
Jayam VK, Dong J, Vasamreddy CR, Lickfett L, Kato R, et al. (2005) Atrial volume reduction following catheter ablation of atrial fibrillation and relation to reduction in pulmonary vein size: An evaluation using magnetic resonance angiography. J Interv Card Electrophysiol13: 107-114.
Sanders P, Morton JB, Morgan JG, Davidson NC, Spence SJ, et al. (2002) Reversal of atrial mechanical stunning after cardioversion of atrial arrhythmias: Implications for the mechanisms of tachycardia-mediated atrial cardiomyopathy. Circulation106: 1806-1813 .
Muller H, Noble S, Keller PF, Siqaud P, Gentil P, et al. (2008) Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: Evidence from real-time three-dimensional echocardiography. Europace 10: 1073-1078.
Luchsinger JA, Steinberg JS (1998) Resolution of cardiomyopathy after ablation of atrial flutter. J Am Coll Cardiol 32: 205-210.
Heinz G, Siostrzonek P, Kreiner G, Gössinger H (1992) Improvement in left ventricular systolic function after successful radiofrequency his bundle ablation for drug refractory, chronic atrial fibrillation and recurrent atrial flutter. Am J Cardiol 69: 489-492.
Cruz FE, Cheriex EC, Smeets JL, Atié J, Peres AK, et al. (1990) Reversibility of tachycardia-induced cardiomyopathy after cure of incessant supraventricular tachycardia. J Am Coll Cardiol16: 739-744.
Spinale FG (1991) Relation between ventricular and myocyte remodeling with the development and regression of supraventricular tachycardia-induced cardiomyopathy. Circ Res 69: 1058-1067.
Stiles MK, Wong CX, John B, Kuklik P, Brooks AG, et al. (2010) Characterization of atrial remodeling studied remote from episodes of typical atrial flutter. Am J Cardiol 106: 528-534.
Medi C, Teh AW, Roberts-Thomson K, Morton JB, Kistler PM, et al. (2012) Right atrial remodeling is more advanced in patients with atrial flutter than with atrial fibrillation. J Cardiovasc Electrophysiol 23: 1067-1072.
Rosenberg MA, Gottdiener JS, Heckbert SR, Mukamal KJ (2012) Echocardiographic diastolic parameters and risk of atrial fibrillation: The cardiovascular health study. Eur Heart J 33: 904-912.
Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, et al. (1990) Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation 82: 792-797.