Top

The International Journal of Cardiovascular Imaging

Published in:

01-03-2019 | Original Paper

Assessment of left atrial remodeling in paroxysmal atrial fibrillation with speckle tracking echocardiography: a study with an electrophysiological mapping system

Authors: Yilin Chen, Zheng Li, Xuedong Shen, Wei Wang, Yu Kang, Zhiqing Qiao, Xinhua Wang, Jun Pu

Published in: The International Journal of Cardiovascular Imaging | Issue 3/2019

Abstract

This study aimed to evaluate left atrial (LA) remodeling and fibrosis in paroxysmal atrial fibrillation (AF) using speckle tracking echocardiography (STE) based on the findings with radiofrequency catheter ablation (RFCA) so as to predict atrial remodeling prior to ablation. A total of 40 patients with paroxysmal AF were enrolled and divided into two groups based on LA bipolar voltage detected during RFCA: those with low-voltage zone (LVZ) (LV group, n = 19) and those without LVZ (non-LV group, n = 21). The segmental and global LA reservoir, conduit and contractile strain (εs, εe, εa) were analyzed using two-dimensional STE before RFCA. The segmental and global εs, εe, εa (%) decreased in the LV group. Especially, the εs in anteroseptal upper (18.32 ± 7.94 vs. 31.61 ± 9.39) and lower segments (16.60 ± 7.23 vs. 29.23 ± 9.81), posteroseptal upper (22.24 ± 6.65 vs. 32.23 ± 10.57) and lower segments (18.24 ± 6.49 vs. 26.40 ± 7.12), and the global εs (23.85 ± 6.74 vs. 30.48 ± 8.67) significantly decreased in the LV group than in the non-LV group (all P < 0.05). The εs ≤ 24.07 in the anteroseptal upper segment was an effective parameter to differentiate the LV group (sensitivity, 84%; specificity, 81%, P < 0.001). Besides, global εs tended to be an independent determinant of the LVZ (odds ratio 1.347, P = 0.046). STE enables a noninvasive method to evaluate LA remodeling prior ablation.

Nademanee K, Lockwood E, Oketani N, Gidney B (2010) Catheter ablation of atrial fibrillation guided by complex fractionated atrial electrogram mapping of atrial fibrillation substrate. J Cardiol 55(1):1–12. https://doi.org/10.1016/j.jjcc.2009.11.002 CrossRefPubMed

Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, Stoylen A, Ihlen H, Lima JA, Smiseth OA, Slordahl SA (2006) Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 47(4):789–793. https://doi.org/10.1016/j.jacc.2005.10.040 CrossRefPubMed

Morris DA, Parwani A, Huemer M, Wutzler A, Bekfani T, Attanasio P, Friedrich K, Kuhnle Y, Haverkamp W, Boldt LH (2013) Clinical significance of the assessment of the systolic and diastolic myocardial function of the left atrium in patients with paroxysmal atrial fibrillation and low CHADS(2) index treated with catheter ablation therapy. Am J Cardiol 111(7):1002–1011. https://doi.org/10.1016/j.amjcard.2012.12.021 CrossRefPubMed

Chadaide S, Domsik P, Kalapos A, Saghy L, Forster T, Nemes A (2013) Three-dimensional speckle tracking echocardiography-derived left atrial strain parameters are reduced in patients with atrial fibrillation (results from the MAGYAR-path study). Echocardiography 30(9):1078–1083. https://doi.org/10.1111/echo.12218 CrossRefPubMed

Mirza M, Caracciolo G, Khan U, Mori N, Saha SK, Srivathsan K, Altemose G, Scott L, Sengupta P, Jahangir A (2011) Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study. J Interv Card Electrophysiol 31(3):197–206. https://doi.org/10.1007/s10840-011-9560-6 CrossRefPubMedPubMedCentral

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, American College of Cardiology/American Heart Association Task Force on Practice G (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64(21):e1–e76. https://doi.org/10.1016/j.jacc.2014.03.022 CrossRefPubMed

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39. https://doi.org/10.1016/j.echo.2014.10.003 CrossRef

Sun JP, Yang Y, Guo R, Wang D, Lee AP, Wang XY, Lam YY, Fang F, Yang XS, Yu CM (2013) Left atrial regional phasic strain, strain rate and velocity by speckle-tracking echocardiography: normal values and effects of aging in a large group of normal subjects. Int J Cardiol 168(4):3473–3479. https://doi.org/10.1016/j.ijcard.2013.04.167 CrossRefPubMed

Lo LW, Tai CT, Lin YJ, Chang SL, Wongcharoen W, Chang SH, Hsieh MH, Tuan TC, Udyavar AR, Chen YJ, Tsao HM, Chen SA (2007) Progressive remodeling of the atrial substrate—a novel finding from consecutive voltage mapping in patients with recurrence of atrial fibrillation after catheter ablation. J Cardiovasc Electrophysiol 18(3):258–265. https://doi.org/10.1111/j.1540-8167.2007.00719.x CrossRefPubMed

10.

Stiles MK, John B, Wong CX, Kuklik P, Brooks AG, Lau DH, Dimitri H, Roberts-Thomson KC, Wilson L, De Sciscio P, Young GD, Sanders P (2009) Paroxysmal lone atrial fibrillation is associated with an abnormal atrial substrate: characterizing the “second factor”. J Am Coll Cardiol 53(14):1182–1191. https://doi.org/10.1016/j.jacc.2008.11.054 CrossRefPubMed

11.

Burstein B, Nattel S (2008) Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol 51(8):802–809. https://doi.org/10.1016/j.jacc.2007.09.064 CrossRefPubMed

12.

Allessie M, Ausma J, Schotten U (2002) Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 54(2):230–246CrossRefPubMed

13.

Callans DJ, Ren JF, Michele J, Marchlinski FE, Dillon SM (1999) Electroanatomic left ventricular mapping in the porcine model of healed anterior myocardial infarction. Correlation with intracardiac echocardiography and pathological analysis. Circulation 100(16):1744–1750CrossRefPubMed

14.

Kottkamp H (2013) Human atrial fibrillation substrate: towards a specific fibrotic atrial cardiomyopathy. Eur Heart J 34(35):2731–2738. https://doi.org/10.1093/eurheartj/eht194 CrossRefPubMed

15.

Platonov PG, Mitrofanova LB, Orshanskaya V, Ho SY (2011) Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol 58(21):2225–2232. https://doi.org/10.1016/j.jacc.2011.05.061 CrossRefPubMed

16.

Mahnkopf C, Badger TJ, Burgon NS, Daccarett M, Haslam TS, Badger CT, McGann CJ, Akoum N, Kholmovski E, Macleod RS, Marrouche NF (2010) Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayed-enhanced MRI: implications for disease progression and response to catheter ablation. Heart Rhythm 7(10):1475–1481. https://doi.org/10.1016/j.hrthm.2010.06.030 CrossRefPubMedPubMedCentral

17.

Oakes RS, Badger TJ, Kholmovski EG, Akoum N, Burgon NS, Fish EN, Blauer JJ, Rao SN, DiBella EV, Segerson NM, Daccarett M, Windfelder J, McGann CJ, Parker D, MacLeod RS, Marrouche NF (2009) Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation 119(13):1758–1767. https://doi.org/10.1161/CIRCULATIONAHA.108.811877 CrossRefPubMedPubMedCentral

18.

Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, Rao SN, Blauer J, Fish EN, Dibella EV, Macleod RS, McGann C, Litwin SE, Marrouche NF (2010) Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 3(3):231–239. https://doi.org/10.1161/CIRCIMAGING.109.865683 CrossRefPubMed

19.

Abhayaratna WP, Fatema K, Barnes ME, Seward JB, Gersh BJ, Bailey KR, Casaclang-Verzosa G, Tsang TS (2008) Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons ≥ 65 years of age. Am J Cardiol 101(11):1626–1629. https://doi.org/10.1016/j.amjcard.2008.01.051 CrossRefPubMed

20.

Hong J, Gu X, An P, Luo T, Lv Q, Kang J, He Y, Hu R, Liu X, Ma C (2013) Left atrial functional remodeling in lone atrial fibrillation: a two-dimensional speckle tracking echocardiographic study. Echocardiography 30(9):1051–1060. https://doi.org/10.1111/echo.12200 CrossRefPubMed

21.

Machino-Ohtsuka T, Seo Y, Tada H, Ishizu T, Machino T, Yamasaki H, Igarashi M, Xu D, Sekiguchi Y, Aonuma K (2011) Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation. J Cardiovasc Electrophysiol 22(9):999–1006. https://doi.org/10.1111/j.1540-8167.2011.02049.x CrossRefPubMed

22.

Tops LF, Delgado V, Bertini M, Marsan NA, Den Uijl DW, Trines SA, Zeppenfeld K, Holman E, Schalij MJ, Bax JJ (2011) Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J Am Coll Cardiol 57(3):324–331. https://doi.org/10.1016/j.jacc.2010.05.063 CrossRefPubMed

23.

Li D, Fareh S, Leung TK, Nattel S (1999) Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation 100(1):87–95CrossRefPubMed

24.

Huo Y, Gaspar T, Pohl M, Sitzy J, Richter U, Neudeck S, Mayer J, Kronborg MB, Piorkowski C (2018) Prevelence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation. Europace 20(6):956–962. https://doi.org/10.1093/europace/eux082 CrossRefPubMed

25.

Sarvari SI, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F, Smiseth OA, Edvardsen T (2016) Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging 17(6):660–667. https://doi.org/10.1093/ehjci/jev185 CrossRefPubMed

26.

Watanabe Y, Nakano Y, Hidaka T, Oda N, Kajihara K, Tokuyama T, Uchimura Y, Sairaku A, Motoda C, Fujiwara M, Kawazoe H, Matsumura H, Kihara Y (2015) Mechanical and substrate abnormalities of the left atrium assessed by 3-dimensional speckle-tracking echocardiography and electroanatomic mapping system in patients with paroxysmal atrial fibrillation. Heart Rhythm 12(3):490–497. https://doi.org/10.1016/j.hrthm.2014.12.007 CrossRefPubMed

27.

Verdejo HE, Becerra E, Zalaquet R, Del Campo A, Garcia L, Troncoso R, Chiong M, Marin A, Castro PF, Lavandero S, Gabrielli L, Corbalan R (2016) Atrial function assessed by speckle tracking echocardiography is a good predictor of postoperative atrial fibrillation in elderly patients. Echocardiography 33(2):242–248. https://doi.org/10.1111/echo.13059 CrossRefPubMed

Title: Assessment of left atrial remodeling in paroxysmal atrial fibrillation with speckle tracking echocardiography: a study with an electrophysiological mapping system
Authors: Yilin Chen
Zheng Li
Xuedong Shen
Wei Wang
Yu Kang
Zhiqing Qiao
Xinhua Wang
Jun Pu
Publication date: 01-03-2019
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 3/2019
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-018-1470-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Assessment of left atrial remodeling in paroxysmal atrial fibrillation with speckle tracking echocardiography: a study with an electrophysiological mapping system

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2019

Reproducibility of global left atrial strain and strain rate between novice and expert using multi-vendor analysis software

Left ventricular myocardial T1 mapping and strain analysis evaluate cardiac abnormality in hypothyroidism

Native T1 mapping to detect extent of acute and chronic myocardial infarction: comparison with late gadolinium enhancement technique

Successful radiofrequency catheter ablation of atrial fibrillation is associated with improvement in left ventricular energy loss and mechanics abnormalities

Influence of age and sex on left ventricular diastolic strain analysis

Relationships of high cardiac output with ventricular morphology, myocardial energetics, and energy costs in hemodialysis patients with preserved ejection fraction

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page