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Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study
AIMS: Little is known about dynamic changes of the left atrial (LA) substrate over time in patients with atrial fibrillation (AF). This study aims to evaluate substrate changes following pulmonary vein isolation (PVI). METHODS AND RESULTS: In our prospective observational study, consecutive patients...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629715/ https://www.ncbi.nlm.nih.gov/pubmed/37787610 http://dx.doi.org/10.1093/europace/euad299 |
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author | Marcon, Lorenzo Bergonti, Marco Spera, Francesco Saenen, Johan Huybrechts, Wim Miljoen, Hielko Van Leuven, Olivier Vandaele, Lien Wittock, Anouk Heidbuchel, Hein Sarkozy, Andrea |
author_facet | Marcon, Lorenzo Bergonti, Marco Spera, Francesco Saenen, Johan Huybrechts, Wim Miljoen, Hielko Van Leuven, Olivier Vandaele, Lien Wittock, Anouk Heidbuchel, Hein Sarkozy, Andrea |
author_sort | Marcon, Lorenzo |
collection | PubMed |
description | AIMS: Little is known about dynamic changes of the left atrial (LA) substrate over time in patients with atrial fibrillation (AF). This study aims to evaluate substrate changes following pulmonary vein isolation (PVI). METHODS AND RESULTS: In our prospective observational study, consecutive patients undergoing first PVI-only and redo ablation were included. High-density maps of the two procedures were compared. Progression or regression was diagnosed if a significant concordant decrease or increase in bipolar voltages in ≥2 segments was observed, respectively. In 28 patients (61.2 ± 9.5 years, 39% female, 53.5% persistent AF), 111.013 voltage points from 56 high-density LA maps (1.982 points/patient) were analysed. Comparing the high-density maps of the first and second procedures, in the progression group (17 patients, 61%), there was a decrease in global (−35%, P < 0.001) and all regional voltages. In the regression group (11 patients, 39%), there was an increase in global (+43%, P < 0.001) and regional voltages. Comparing the progression with the regression group, the area of low-voltage zone (LVZ) increased (+3.5 vs. −4.5 cm(2), P < 0.001) and LA activation time prolonged (+8.0 vs. −9.1 ms, P = 0.005). Baseline clinical parameters did not predict progression or regression. In patients with substrate progression, pulmonary veins (PVs) were more frequently isolated (P = 0.02) and the AF pattern at recurrence was more frequently persistent (P = 0.005). CONCLUSION: Our study describes bidirectional dynamic properties of the LA substrate with concordant either progressive or regressive changes. Regression occurs with reduced AF burden after the first procedure, while progression is associated with persistent AF recurrence despite durable PV isolation. The dynamic nature of LA substrate poses questions about LVZ-based ablation strategies. |
format | Online Article Text |
id | pubmed-10629715 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106297152023-11-08 Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study Marcon, Lorenzo Bergonti, Marco Spera, Francesco Saenen, Johan Huybrechts, Wim Miljoen, Hielko Van Leuven, Olivier Vandaele, Lien Wittock, Anouk Heidbuchel, Hein Sarkozy, Andrea Europace Clinical Research AIMS: Little is known about dynamic changes of the left atrial (LA) substrate over time in patients with atrial fibrillation (AF). This study aims to evaluate substrate changes following pulmonary vein isolation (PVI). METHODS AND RESULTS: In our prospective observational study, consecutive patients undergoing first PVI-only and redo ablation were included. High-density maps of the two procedures were compared. Progression or regression was diagnosed if a significant concordant decrease or increase in bipolar voltages in ≥2 segments was observed, respectively. In 28 patients (61.2 ± 9.5 years, 39% female, 53.5% persistent AF), 111.013 voltage points from 56 high-density LA maps (1.982 points/patient) were analysed. Comparing the high-density maps of the first and second procedures, in the progression group (17 patients, 61%), there was a decrease in global (−35%, P < 0.001) and all regional voltages. In the regression group (11 patients, 39%), there was an increase in global (+43%, P < 0.001) and regional voltages. Comparing the progression with the regression group, the area of low-voltage zone (LVZ) increased (+3.5 vs. −4.5 cm(2), P < 0.001) and LA activation time prolonged (+8.0 vs. −9.1 ms, P = 0.005). Baseline clinical parameters did not predict progression or regression. In patients with substrate progression, pulmonary veins (PVs) were more frequently isolated (P = 0.02) and the AF pattern at recurrence was more frequently persistent (P = 0.005). CONCLUSION: Our study describes bidirectional dynamic properties of the LA substrate with concordant either progressive or regressive changes. Regression occurs with reduced AF burden after the first procedure, while progression is associated with persistent AF recurrence despite durable PV isolation. The dynamic nature of LA substrate poses questions about LVZ-based ablation strategies. Oxford University Press 2023-10-03 /pmc/articles/PMC10629715/ /pubmed/37787610 http://dx.doi.org/10.1093/europace/euad299 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Research Marcon, Lorenzo Bergonti, Marco Spera, Francesco Saenen, Johan Huybrechts, Wim Miljoen, Hielko Van Leuven, Olivier Vandaele, Lien Wittock, Anouk Heidbuchel, Hein Sarkozy, Andrea Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study |
title | Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study |
title_full | Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study |
title_fullStr | Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study |
title_full_unstemmed | Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study |
title_short | Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study |
title_sort | dynamic changes of left atrial substrate over time following pulmonary vein isolation: the progress-af study |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629715/ https://www.ncbi.nlm.nih.gov/pubmed/37787610 http://dx.doi.org/10.1093/europace/euad299 |
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