Anatomical and functional remodeling of the left atrium in patients with paroxysmal and persistent atrial fibrillation after cryoballoon isolation of pulmonary vein orifices

Authors: Avanesyan G.A., Filatov A.G., Shalov R.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-1-59-72

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



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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.

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About Authors

  • Grayr A. Avanesyan, Postgraduate; ORCID
  • Andrey G. Filatov, Dr. Med. Sci., Head of Department; ORCID
  • Ruslan Z. Shalov, Junior Researcher; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery