Atrial fibrillation (AF) is a major cause of cardiovascular morbidity and mortality. To early detect and to avoid AF-related complications, several cardiac imaging modalities and approaches aim to... Show moreAtrial fibrillation (AF) is a major cause of cardiovascular morbidity and mortality. To early detect and to avoid AF-related complications, several cardiac imaging modalities and approaches aim to quantify the severity of the underlying atrial cardiomyopathy (i.e., the extent of atrial remodeling). However, most established cardiac imaging modalities just incorporate single components of atrial remodeling and do not reflect the complete multifactorial process, which may contribute to their limited predictive value. Echocardiography-derived PA-TDI duration is a sophisticated echocardiographic parameter to assess total atrial conduction time and directly reflects both electrical and structural changes to the atria. Therefore, PA-TDI duration provides a more comprehensive quantification of the extent of atrial remodeling than other imaging modalities. In this article we review the role of PA-TDI duration as a marker of atrial remodeling and summarize the available data on PA-TDI duration to identify patients at risk for AF, as well as to guide AF management. Moreover, we discuss how to assess PA-TDI duration and provide recommendations on the implementation of PA-TDI duration into routine clinical care. Graphic abstract Show less
Radiofrequency catheter ablation (RFCA) has become an important treatment option in the management of supraventricular arrhythmias such as atrioventricular (nodal) re-entry tachycardia, atrial... Show moreRadiofrequency catheter ablation (RFCA) has become an important treatment option in the management of supraventricular arrhythmias such as atrioventricular (nodal) re-entry tachycardia, atrial tachycardia, atrial flutter and atrial fibrillation (AF). Particularly in the management of AF the number of RFCA procedures performed is growing rapidly. Three-dimensional electroanatomical mapping combined with non-invasive imaging is currently a state of the art technique to guide RFCA for complex arrhythmias such as AF ablation, providing information on anatomical landmarks and arrhythmogenic substrate with higher accuracy and with less radiation exposure than fluoroscopy or conventional catheter based mapping. Importantly, accurate characterization of the arrhythmogenic substrate and the underlying mechanisms of the arrhythmia as well as visualization of anatomical landmarks are pivotal to optimize the results of RFCA. Comprehensive pre-procedural evaluation may help to identify the appropriate substrate as well as to identify patients with a high likelihood to benefit from a RFCA procedure. Show less
Uijl, D.W. den; Boogers, M.J.; Compier, M.; Trines, S.A.; Scholte, A.J.H.A.; Zeppenfeld, K.; ... ; Delgado, V. 2013
AIMS Coronary atherosclerosis has been associated with the development of atrial fibrillation (AF). However, little is known about the impact of coronary atherosclerosis on the outcome treatment of... Show moreAIMS Coronary atherosclerosis has been associated with the development of atrial fibrillation (AF). However, little is known about the impact of coronary atherosclerosis on the outcome treatment of AF. The aim of this study was to investigate the impact of coronary atherosclerosis on the efficacy of radiofrequency catheter ablation (RFCA) for AF using multi-detector row computed tomography (MDCT). METHODS In 125 consecutive patients undergoing RFCA for AF, a pre-procedural MDCT examination (coronary angiography and/or coronary calcium score) was performed to evaluate the presence and severity of coronary atherosclerosis. Furthermore, all patients underwent a comprehensive echocardiographic evaluation to measure the left atrial size and to rule out structural heart disease. After RFCA all patients were regularly evaluated at the outpatient clinic. RESULTS After a mean follow-up of 12 ± 3 months, 78 patients (62%) had maintained stable sinus rhythm and 47 patients (38%) had recurrence of AF. Left atrial volume index was a significant predictor of AF recurrence after RFCA. The presence of coronary atherosclerosis on MDCT did not influence the efficacy of RFCA for AF. CONCLUSIONS The presence of coronary atherosclerosis on MDCT is not associated with a higher risk for AF recurrence after RFCA. Show less
BACKGROUND Radiofrequency catheter ablation (RFCA) for idiopathic right ventricular outflow tract (RVOT) arrhythmias is typically guided by local activation time (LAT) mapping and unipolar... Show moreBACKGROUND Radiofrequency catheter ablation (RFCA) for idiopathic right ventricular outflow tract (RVOT) arrhythmias is typically guided by local activation time (LAT) mapping and unipolar electrogram morphology (QS configuration). However, LAT mapping is limited by the large variation among patients, and the area demonstrating a QS configuration of the unipolar electrogram may be larger than the focal source. Reversed polarity has been proposed as a criterion for guiding RFCA. OBJECTIVE The purpose of this study was to investigate the value of reversed polarity of adjacent bipolar electrograms for predicting a successful ablation site in idiopathic RVOT arrhythmias. METHODS Twenty-five consecutive patients (12 men [ 48%], age 43 +/- 15 years) undergoing RFCA for RVOT arrhythmia were studied. Electrograms of ablation sites and of points within a 15-mm radius to the successful site were evaluated for LAT, unipolar electrogram morphology, and the presence of reversed polarity of adjacent bipolar electrograms. Electrogram characteristics of successful ablation sites were compared to those of nonsuccessful ablation sites. The spatial distribution of each electrogram characteristic was studied. RESULTS Successful ablation sites more often demonstrated reversed polarity and had an earlier LAT than nonsuccessful sites. A wide spatial distribution was observed for unipolar electrograms with a QS configuration around the successful ablation site. Mapping based on LAT and reversed polarity had a higher predictive value for a successful ablation site than mapping based on LAT and QS configuration. CONCLUSION The presence of reversed polarity has a high predictive value for successful ablation sites in focal idiopathic RVOT arrhythmias and is likely to reduce the number of RFCA applications. Show less
Background The presence of atrial fibrillation (AF) is related to increased levels of natriuretic peptides. In addition, increased natriuretic peptide levels are predictive of the development of AF... Show moreBackground The presence of atrial fibrillation (AF) is related to increased levels of natriuretic peptides. In addition, increased natriuretic peptide levels are predictive of the development of AF. However, the role of natriuretic peptides to predict recurrence of AF after radiofrequency catheter ablation (RFCA) is controversial. Objective The study aimed to investigate the role of natriuretic peptides in the prediction of AF recurrence after RFCA for AF. Methods Pre-procedural amino-terminal pro-atrial natriuretic peptide (NT-proANP) and amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) plasma levels were determined in 87 patients undergoing RFCA for symptomatic drug-refractory AF. In addition, a comprehensive clinical and echocardiographic evaluation was performed at baseline. Left atrial volumes, left ventricular volumes, and function (systolic and diastolic) were assessed. During a 6-month follow-up period, AF recurrence was monitored and defined as any registration of AF on electrocardiogram or an episode of AF longer than 30 seconds on 24-hour Holter monitoring. The role of natriuretic peptide plasma levels to predict AF recurrence after RFCA was studied. Results During follow-up, 66 patients (76%) maintained sinus rhythm, whereas 21 patients (24%) had AF recurrence. Patients with AF recurrence had higher baseline natriuretic peptide levels than patients who maintained sinus rhythm (NT-proANP 3.19 nmol/L [2.55-4.28] vs 2.52 nmol/L [1.69-3.55], P = .030; NT-proBNP 156.4 pg/mL [64.1-345.3] vs 84.6 pg/mL [43.3-142.7], P = .036). However, NT-proBNP was an independent predictor of AF recurrence, whereas NT-proANP was not. Moreover, NT-proBNP had an incremental value over echocardiographic characteristics to predict AF recurrence after RFCA. Conclusion Baseline NT-proBNP plasma level is an independent predictor of AF recurrence after RFCA. (Am Heart J 2011;161:197-203.) Show less
Objectives The purpose of this study was to assess left atrial (LA) strain during long-term follow-up after catheter ablation for atrial fibrillation and to find predictors for LA reverse... Show moreObjectives The purpose of this study was to assess left atrial (LA) strain during long-term follow-up after catheter ablation for atrial fibrillation and to find predictors for LA reverse remodeling. Background The association between LA reverse remodeling and improvement in LA strain after catheter ablation has not been investigated thus far. Methods In 148 patients undergoing catheter ablation for atrial fibrillation, LA volumes and LA strain were assessed with echocardiography at baseline and after a mean of 13.2 +/- 6.7 months of follow-up. The study population was divided according to LA reverse remodeling at follow-up: responders were defined as patients who exhibited 15% or more reduction in maximum LA volume at long-term follow-up. Left atrial systolic (LAs) strain was assessed with tissue Doppler imaging. Results At follow-up, 93 patients (63%) were classified as responders, whereas 55 patients (37%) were nonresponders. At baseline, LAs strain was significantly higher in the responders as compared with the nonresponders (19 +/- 8% vs. 14 +/- 6%; p = 0.001). Among the responders, a significant increase in LAs strain was noted from baseline to follow-up (from 19 +/- 8% to 22 +/- 9%; p < 0.05), whereas no change was noted among the nonresponders. LAs strain at baseline was an independent predictor of LA reverse remodeling (odds ratio: 1.813; 95% confidence interval: 1.102 to 2.982; p = 0.019). Conclusions In the present study, 63% of the patients exhibited LA reverse remodeling after catheter ablation for atrial fibrillation, with a concomitant improvement in LA strain. LA strain at baseline was an independent predictor of LA reverse remodeling. (J Am Coll Cardiol 2011;57:324-31) (C) 2011 by the American College of Cardiology Foundation Show less
OBJECTIVES The purpose of this study was to assess left atrial (LA) strain during long-term follow-up after catheter ablation for atrial fibrillation and to find predictors for LA reverse... Show moreOBJECTIVES The purpose of this study was to assess left atrial (LA) strain during long-term follow-up after catheter ablation for atrial fibrillation and to find predictors for LA reverse remodeling. BACKGROUND The association between LA reverse remodeling and improvement in LA strain after catheter ablation has not been investigated thus far. METHODS In 148 patients undergoing catheter ablation for atrial fibrillation, LA volumes and LA strain were assessed with echocardiography at baseline and after a mean of 13.2 ± 6.7 months of follow-up. The study population was divided according to LA reverse remodeling at follow-up: responders were defined as patients who exhibited 15% or more reduction in maximum LA volume at long-term follow-up. Left atrial systolic (LAs) strain was assessed with tissue Doppler imaging. RESULTS At follow-up, 93 patients (63%) were classified as responders, whereas 55 patients (37%) were nonresponders. At baseline, LAs strain was significantly higher in the responders as compared with the nonresponders (19 ± 8% vs. 14 ± 6%; p = 0.001). Among the responders, a significant increase in LAs strain was noted from baseline to follow-up (from 19 ± 8% to 22 ± 9%; p < 0.05), whereas no change was noted among the nonresponders. LAs strain at baseline was an independent predictor of LA reverse remodeling (odds ratio: 1.813; 95% confidence interval: 1.102 to 2.982; p = 0.019). CONCLUSIONS In the present study, 63% of the patients exhibited LA reverse remodeling after catheter ablation for atrial fibrillation, with a concomitant improvement in LA strain. LA strain at baseline was an independent predictor of LA reverse remodeling. Show less
Multislice computed tomography (MSCT) is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) to plan and guide the procedure. MSCT allows accurate... Show moreMultislice computed tomography (MSCT) is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) to plan and guide the procedure. MSCT allows accurate measurement of the left atrial (LA) and pulmonary vein (PV) dimensions and classification of the PV anatomy. The aim of the present study was to investigate the effect of LA dimensions, PV dimensions, and PV anatomy on the outcome of circumferential RFCA for AF. A total of 100 consecutive patients undergoing RFCA for AF (paroxysmal 72%, persistent 28%) were studied. The LA dimensions, PV dimensions, and PV anatomy were evaluated three dimensionally using MSCT. The PV anatomy was classified as normal or atypical according to the absence/presence of a common trunk or additional veins. After a mean follow-up of 11.6 ± 2.8 months, 65 patients (65%) maintained sinus rhythm. The enlargement of the left atrium in the anteroposterior direction on MSCT was related to a greater risk of AF recurrence. No relation was found between the PV dimensions and the outcome of RFCA. In addition, normal right-sided PV anatomy was related to a greater risk of AF recurrence compared to atypical right-sided PV anatomy. Multivariate analysis showed that an anteroposterior LA diameter on MSCT (odds ratio 1.083, p = 0.027) and normal right-sided PV anatomy (odds ratio 6.711, p = 0.006) were independent predictors of AF recurrence after RFCA. In conclusion, enlargement of the anteroposterior LA diameter and the presence of normal anatomy of the right PVs are independent risk factors for AF recurrence. No relation was found between the PV dimensions and outcome of RFCA. Show less
Multislice computed tomography (MSCT) is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) to plan and guide the procedure. MSCT allows accurate... Show moreMultislice computed tomography (MSCT) is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) to plan and guide the procedure. MSCT allows accurate measurement of the left atrial (LA) and pulmonary vein (PV) dimensions and classification of the PV anatomy. The aim of the present study was to investigate the effect of LA dimensions, PV dimensions, and PV anatomy on the outcome of circumferential RFCA for AF. A total of 100 consecutive patients undergoing RFCA for AF (paroxysmal 72%, persistent 28%) were studied. The LA dimensions, PV dimensions, and PV anatomy were evaluated three dimensionally using MSCT. The PV anatomy was classified as normal or atypical according to the absence/presence of a common trunk or additional veins. After a mean follow-up of 11.6 +/- 2.8 months, 65 patients (65%) maintained sinus rhythm. The enlargement of the left atrium in the anteroposterior direction on MSCT was related to a greater risk of AF recurrence. No relation was found between the PV dimensions and the outcome of RFCA. In addition, normal right-sided PV anatomy was related to a greater risk of AF recurrence compared to atypical right-sided PV anatomy. Multivariate analysis showed that an anteroposterior LA diameter on MSCT (odds ratio 1.083, p = 0.027) and normal right-sided PV anatomy (odds ratio 6.711, p = 0.006) were independent predictors of AF recurrence after RFCA. In conclusion, enlargement of the anteroposterior LA diameter and the presence of normal anatomy of the right PVs are independent risk factors for AF recurrence. No relation was found between the PV dimensions and outcome of RFCA. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:243-249) Show less
Taxis, C.F.B.V. van; Wijnmaalen, A.P.; Uijl, D.W. den; Gawrysiak, M.; Putter, H.; Schalij, M.J.; Zeppenfeld, K. 2011
BACKGROUND:: Radiofrequency catheter ablation (RFCA) for idiopathic right ventricular outflow tract (RVOT) arrhythmias is typically guided by local activation time (LAT) mapping and unipolar... Show moreBACKGROUND:: Radiofrequency catheter ablation (RFCA) for idiopathic right ventricular outflow tract (RVOT) arrhythmias is typically guided by local activation time (LAT) mapping and unipolar electrogram morphology (QS-configuration). However, LAT mapping is limited by the large variation among patients and the area demonstrating a QS-configuration of the unipolar electrogram may be larger than the focal source. Reversed polarity has been proposed as criterion to guide RFCA. OBJECTIVE:: The aim of this study was to investigate the value of reversed polarity of adjacent bipolar electrograms to predict a successful ablation site in idiopathic RVOT arrhythmias. METHODS:: Twenty-five consecutive patients (12 male [48%], 43±15 years) undergoing RFCA for RVOT arrhythmia were studied. Electrograms of ablation sites and of points within a 15mm radius to the successful site were evaluated for LAT, unipolar electrogram morphology and the presence of reversed polarity of adjacent bipolar electrograms. Electrogram characteristics of successful ablation sites were compared to non-successful ablation sites. The spatial distribution of each electrogram characteristic was studied. RESULTS:: Successful ablation sites more often demonstrated reversed polarity and had an earlier LAT than non-successful sites. A wide spatial distribution was observed for unipolar electrograms with a QS-configuration around the successful ablation site. Mapping based on LAT and reversed polarity had a higher predictive value for a successful ablation site than mapping based on LAT and QS-configuration. CONCLUSION:: The presence of reversed polarity has a high predictive value for successful ablation sites in focal idiopathic RVOT arrhythmias and is likely to reduce the number of RFCA applications. Show less
Background-Left ventricular (LV) fibrosis is important for the response to cardiac resynchronization therapy (CRT). Calibrated integrated backscatter derived by 2D echocardiography quantifies... Show moreBackground-Left ventricular (LV) fibrosis is important for the response to cardiac resynchronization therapy (CRT). Calibrated integrated backscatter derived by 2D echocardiography quantifies myocardial ultrasound reflectivity, which may provide a surrogate of LV fibrosis. The aim of the study was first, to investigate the relation of myocardial ultrasound reflectivity assessed with calibrated integrated backscatter on CRT response, and second, to explore the "myocardial ultrasound reflectivity-CRT response" relation in patients with ischemic and nonischemic heart failure (HF). Methods and Results-One hundred fifty-nine patients with HF referred for CRT underwent an extensive echocardiographic evaluation at baseline and at 6-month follow-up. LV dyssynchrony was derived from speckle-tracking analysis. Calibrated integrated backscatter was obtained from the parasternal long-axis view. The mean value of calibrated integrated backscatter of the anteroseptal and posterior wall was used to estimate myocardial ultrasound reflectivity. CRT response was defined as reduction >= 15% of LV end-systolic volume. At baseline, LV dyssynchrony was significantly larger in responders as compared with nonresponders (188 +/- 96 ms versus 115 +/- 68 ms, P<0.001), and CRT responders showed less myocardial ultrasound reflectivity as compared with nonresponders (-20.8 +/- 3.0 dB versus -17.0 +/- 3.0 dB, P<0.001). In multivariable logistic regression analysis, independent predictors for CRT response were LV dyssynchrony, renal function, and myocardial ultrasound reflectivity. Importantly, myocardial ultrasound reflectivity provided an incremental value to CRT response (chi(2) change=40, P<0.001). Considering patients with ischemic HF, the only independent predictor of CRT response was myocardial ultrasound reflectivity, whereas in patients with nonischemic HF, independent predictors of LV reverse remodeling were myocardial ultrasound reflectivity, LV dyssynchrony, and renal function. Conclusions-Assessment of myocardial ultrasound reflectivity is important in the prediction of CRT response in ischemic and nonischemic patients. (Circ Cardiovasc Imaging. 2010;3:86-93.) Show less
