Cargando…

Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion

BACKGROUND: Diastolic dysfunction promotes atrial fibrillation (AF) inducing left atrial (LA) remodeling, with chamber dilation and fibrosis. Predominance of LA phasic conduit (LAC) function should reflect not only chamber alterations but also underlying left ventricular (LV) filling impairment. Thu...

Descripción completa

Detalles Bibliográficos
Autores principales: Degiovanni, Anna, Boggio, Enrico, Prenna, Eleonora, Sartori, Chiara, De Vecchi, Federica, Marino, Paolo N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869942/
https://www.ncbi.nlm.nih.gov/pubmed/29181725
http://dx.doi.org/10.1007/s00392-017-1188-9
_version_ 1783309374027988992
author Degiovanni, Anna
Boggio, Enrico
Prenna, Eleonora
Sartori, Chiara
De Vecchi, Federica
Marino, Paolo N.
author_facet Degiovanni, Anna
Boggio, Enrico
Prenna, Eleonora
Sartori, Chiara
De Vecchi, Federica
Marino, Paolo N.
author_sort Degiovanni, Anna
collection PubMed
description BACKGROUND: Diastolic dysfunction promotes atrial fibrillation (AF) inducing left atrial (LA) remodeling, with chamber dilation and fibrosis. Predominance of LA phasic conduit (LAC) function should reflect not only chamber alterations but also underlying left ventricular (LV) filling impairment. Thus, LAC was tested as possible predictor of early AF relapse after electrical cardioversion (EC). METHODS: 96 consecutive patients, who underwent EC for persistent non-valvular AF, were prospectively enrolled. Immediately after successful EC (3 h ± 15 min), an echocardiographic apical four-chamber view was acquired with transmitral velocities, annular tissue Doppler and simultaneous LV and LA three-dimensional full-volume datasets. Then, from LA–LV volumetric curves we computed LAC as: [(LV maximum − LV minimum) − (LA maximum − LA minimum) volume], expressed as % LV stroke volume. LA pump, immediately post-EC, was assumed and verified as being negligible. Sinus rhythm persistence at 1 month was checked with ECG-Holter monitoring. RESULTS: At 1 month 62 patients were in sinus rhythm and 34 in AF. AF patients presented pre-EC higher E/é values (p = 0.012), no major LA volume differences (p = NS), but a stiffer LV cavity (p = 0.012) for a comparable LV capacitance (p = 0.461). Conduit contributed more (p < 0.001) to LV stroke volume in AF subpopulation. Multiple regression revealed LAC as the most significant AF predictor (p = 0.013), even after correction for biometric characteristics and pharmacotherapy (p = 0.008). CONCLUSION: Our data suggest that LAC larger contribution to LV filling soon after EC reflects LA–LV stiffening, which skews atrioventricular interaction leading to AF perpetuation and makes conduit dominance a powerful predictor of early AF recurrence. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00392-017-1188-9) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5869942
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-58699422018-03-28 Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion Degiovanni, Anna Boggio, Enrico Prenna, Eleonora Sartori, Chiara De Vecchi, Federica Marino, Paolo N. Clin Res Cardiol Original Paper BACKGROUND: Diastolic dysfunction promotes atrial fibrillation (AF) inducing left atrial (LA) remodeling, with chamber dilation and fibrosis. Predominance of LA phasic conduit (LAC) function should reflect not only chamber alterations but also underlying left ventricular (LV) filling impairment. Thus, LAC was tested as possible predictor of early AF relapse after electrical cardioversion (EC). METHODS: 96 consecutive patients, who underwent EC for persistent non-valvular AF, were prospectively enrolled. Immediately after successful EC (3 h ± 15 min), an echocardiographic apical four-chamber view was acquired with transmitral velocities, annular tissue Doppler and simultaneous LV and LA three-dimensional full-volume datasets. Then, from LA–LV volumetric curves we computed LAC as: [(LV maximum − LV minimum) − (LA maximum − LA minimum) volume], expressed as % LV stroke volume. LA pump, immediately post-EC, was assumed and verified as being negligible. Sinus rhythm persistence at 1 month was checked with ECG-Holter monitoring. RESULTS: At 1 month 62 patients were in sinus rhythm and 34 in AF. AF patients presented pre-EC higher E/é values (p = 0.012), no major LA volume differences (p = NS), but a stiffer LV cavity (p = 0.012) for a comparable LV capacitance (p = 0.461). Conduit contributed more (p < 0.001) to LV stroke volume in AF subpopulation. Multiple regression revealed LAC as the most significant AF predictor (p = 0.013), even after correction for biometric characteristics and pharmacotherapy (p = 0.008). CONCLUSION: Our data suggest that LAC larger contribution to LV filling soon after EC reflects LA–LV stiffening, which skews atrioventricular interaction leading to AF perpetuation and makes conduit dominance a powerful predictor of early AF recurrence. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00392-017-1188-9) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2017-11-27 2018 /pmc/articles/PMC5869942/ /pubmed/29181725 http://dx.doi.org/10.1007/s00392-017-1188-9 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Paper
Degiovanni, Anna
Boggio, Enrico
Prenna, Eleonora
Sartori, Chiara
De Vecchi, Federica
Marino, Paolo N.
Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion
title Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion
title_full Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion
title_fullStr Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion
title_full_unstemmed Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion
title_short Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion
title_sort association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869942/
https://www.ncbi.nlm.nih.gov/pubmed/29181725
http://dx.doi.org/10.1007/s00392-017-1188-9
work_keys_str_mv AT degiovannianna associationbetweenleftatrialphasicconduitfunctionandearlyatrialfibrillationrecurrenceinpatientsundergoingelectricalcardioversion
AT boggioenrico associationbetweenleftatrialphasicconduitfunctionandearlyatrialfibrillationrecurrenceinpatientsundergoingelectricalcardioversion
AT prennaeleonora associationbetweenleftatrialphasicconduitfunctionandearlyatrialfibrillationrecurrenceinpatientsundergoingelectricalcardioversion
AT sartorichiara associationbetweenleftatrialphasicconduitfunctionandearlyatrialfibrillationrecurrenceinpatientsundergoingelectricalcardioversion
AT devecchifederica associationbetweenleftatrialphasicconduitfunctionandearlyatrialfibrillationrecurrenceinpatientsundergoingelectricalcardioversion
AT marinopaolon associationbetweenleftatrialphasicconduitfunctionandearlyatrialfibrillationrecurrenceinpatientsundergoingelectricalcardioversion
AT associationbetweenleftatrialphasicconduitfunctionandearlyatrialfibrillationrecurrenceinpatientsundergoingelectricalcardioversion