Anatomical and functional remodeling of the left atrium in patients with paroxysmal and persistent atrial fibrillation after cryoballoon isolation of pulmonary vein orifices
Authors:
Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
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Type: Original articles
DOI:
For citation: Avanesyan G.A., Filatov A.G., Shalov R.Z. Anatomical and functional remodeling of the left atrium in patients with paroxysmal and persistent atrial fibrillation after cryoballoon isolation of pulmonary vein orifices. Creative Cardiology. 2024; 18 (1): 59–72 (in Russ.). DOI: 10.24022/1997-3187-2024-18-1-59-72
Received / Accepted: 25.10.2023 / 11.12.2023
Keywords: atrial fibrillation treatment cryoballoon ablation cryoisolation of pulmonary vein orifices intracardiac ultrasound
Abstract
Objective. Assessment of anatomical and functional remodeling of the left atrium in patients with paroxysmal and persistent atrial fibrillation after cryoballoon ablation (CBA) of the pulmonary vein ostia.
Material and methods. The follow-up period ranged from 4 to 17 months (mean follow-up period was 8.4±2.6 months). In total, the study included 100 patients who met the selection criteria. Depending on the form and duration of atrial fibrillation (AF) paroxysms documented by electrocardiography and Holter monitoring, patients were divided into two groups. The first group included 57 (57%) patients with paroxysmal AF, and the second group included 43 (43%) patients with persistent AF.
Results. Arrhythmia recurrence was documented in 32 patients during the follow-up period. We analyzed the recurrence group depending on the form of AF, it was found that in patients with a persistent form of AF, the recurrence rate is higher than in patients with paroxysmal AF (19 out of 43 (44.2%) and 13 out of 57 (22.8 %) of patients, respectively). The chances of recurrence in the persistent form group were 2.679 times higher than in the paroxysmal group, the difference in odds was statistically significant (odds ratio (OR) 1.594; 95% confidence interval (CI) 1.130–6.352) (p<0.023). In the analysis of data on the results of echocardiography, the main differences in the relapse group and without were presented in the peak atrial longitudinal strain (PALS) value of 27.0 [24.6–28.2] and 29.4 [27.3–31.1] (p<0.001). An analysis of the data obtained during multispiral computed tomography of the left atrium (LA) and pulmonary veins (PV) was also carried out. Statistically significant differences were found in the relapse group and without in the following parameters: in the volume of the left atrium with the appendage 128 [119–159] and 116 [102–130] ml and in the indexed volume of LA 69.0 [65.3– 72.6] and 58.4 [56.2–60.6] ml/m2 (p<0.001 and p<0.001, respectively). The multivariate Cox analysis showed predictors, an exceptional effect on the risk of AF recurrence after cryoballoon transport of drugs: the presence of diabetes mellitus led to the risk of AF recurrence by 2.39, incomplete isolation of the PV by 3.98 times, the value of LA≥61.9 ml/m2 in 2.91 times.
Conclusion. The study of the mechanisms of development and maintenance of AF plays an important role in the development of a strategy for the treatment of patients with various forms of AF. The study of LA remodeling will make it possible to identify early predictors of AF recurrence, which in turn will help to more effectively and timely adjust drug and interventional treatment.
References
- Su W.W., Reddy V.Y., Bhasin K., Champagne J., Sangrigoli R.M., Braegelmann K.M. et al. Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: Results from the multicenter STOP persistent AF trial. Heart Rhythm. 2020; 17 (11): 1841–1847. DOI: 10.1016/j.hrthm.2020.06.020
- Peng X., Liu X., Tian H., Chen Y., Li X. Effects of hot balloon vs. cryoballoon ablation for atrial fibrillation: a systematic review, meta-analysis, and meta-regression. Front. Cardiovasc. Med. 2021; 8: 787270. DOI: 10.3389/fcvm.2021.787270
- Golukhova E.Z., Milievskaya E.B., Filatov A.G., Semenov V.Yu., Pryanishnikov V.V. Arrhythmology – 2021. Heart rhythm and conduction disorders. Moscow; 2022 (in Russ.).
- Clinical recommendations of the Ministry of Health of the Russian Federation for the treatment of patients with atrial flutter and fibrillation. Clinical guidelines – Atrial fibrillation and flutter in adults – 2021 (06/10/2021) (in Russ.).
- Chun K.R.J., Okumura K., Scazzuso F., Keun On Y., Kueffer F.J., Braegelmann K.M. Safety and efficacy of cryoballoon ablation for the treatment of paroxysmal and persistent AF in a real-world global setting: Results from the Cryo AF Global Registry. J. Arrhythm. 2021; 37 (2): 356–367. DOI: 10.1002/joa3.12504
- Tondo C., Iacopino S., Pieragnoli P., Molon G., Verlato R., Curnis A. et al. Pulmonary vein isolation cryoablation for patients with persistent and long-standing persistent atrial fibrillation: Clinical outcomes from the real-world multicenter observational project. Heart Rhythm. 2018; 15 (3): 363–368. DOI: 10.1016/ j.hrthm.2017.10.038
- Park J.H., Hwang I.C., Park J.J., Park J.B., Cho G.Y. Prognostic power of left atrial strain in patients with acute heart failure. Eur. Heart J. Cardiovasc. Imaging. 2021; 22 (2): 210–219. DOI: 10.1093/ehjci/jeaa013
- Jia F., Chen A., Zhang D., Fang L., Chen W. Prognostic value of left atrial strain in heart failure: a systematic review and meta-analysis. Front. Cardiovasc. Med. 2022; 9: 935103. DOI: 10.3389/fcvm.2022.935103
- Averina I.I., Mironenko M.Yu., Glushko L.A., Donakanyan S.A., Bockeria L.A. Remodeling of the left heart as a risk factor for the development of atrial fibrillation in patients after correction of acquired heart defects. Russian Journal of Cardiology. 2023; 28 (7): 5323 (in Russ.). DOI: 10.15829/1560-4071-2023-5323
- Boveda S., Metzner A., Nguyen D.Q., Chun K.R.J., Goehl K., Noelker G. et al. Single-procedure outcomes and qualityof-life improvement 12 months post-cryoballoon ablation in persistent atrial fibrillation: results from the multicenter CRYO4PERSISTENT AF trial. JACC Clin. Electrophysiol. 2018; 4 (11): 1440–1447. DOI: 10.1016/j.jacep.2018.07.007
- Georgiopoulos G., Tsiachris D., Manolis A.S. Cryoballoon ablation of atrial fibrillation: a practical and effective approach. Clin. Cardiol. 2017; 40 (5): 333–342. DOI: 10.1002/clc.22653
- Chen S., Schmidt B., Bordignon S., Bologna F., Perrotta L., Nagase T., Chun K.R.J. Atrial fibrillation ablation using cryoballoon technology: recent advances and practical techniques. J. Cardiovasc. Electrophysiol. 2018; 29 (6): 932–943. DOI: 10.1111/jce.13607
- Akhtar T., Berger R., Marine J.E., Daimee U.A., Calkins H., Spragg D. Cryoballoon ablation of atrial fibrillation in octogenarians. Arrhythm. Electrophysiol. Rev. 2020; 9 (2): 104–107. DOI: 10.15420/aer.2020.18
- Albano J.A., Bush J., Parker L.J., Corner K., Lim W.H., Brunner P.M. et al. Left atrial volume index predicts arrhythmia-free survival in patients with persistent atrial fibrillation undergoing cryoballoon ablation. J. Atr. Fibrillation. 2019; 12 (2): 2192. DOI: 10.4022/jafib.2192