TY - JOUR
T1 - Cardiac magnetic resonance-derived right atrial functional analysis in patients with atrial fibrillation and typical atrial flutter
AU - Gucuk Ipek, Esra
AU - Habibi, Mohammadali
AU - Zghaib, Tarek
AU - Zimmerman, Stefan L.
AU - Calkins, Hugh
AU - Lima, Joao
AU - Nazarian, Saman
N1 - Funding Information:
The study was funded by NIH grants K23HL089333 and R01HL116280 as well as a Biosense-Webster grant to Dr. Nazarian, The Roz and Marvin H Weiner and Family Foundation, The Dr. Francis P. Chiaramonte Foundation, The Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund, and The Marilyn and Christian Poindexter Arrhythmia Research Fund.
Funding Information:
Dr. Nazarian receives research funding from Biosense Webster, ImriCor, Siemens, and NIH/NHLBI; and is a consultant to CardioSolv and Circle Software.
Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: Typical atrial flutter (AFL) often occurs in patients with atrial fibrillation (AF). Decision-making tools for application of prophylactic cavo-tricuspid isthmus (CTI) ablation at the time of AF ablation may improve outcomes. In this study, we sought to define the right atrial (RA) functional characteristics of AF patients with documented typical AFL. Methods: Consecutive patients that underwent cardiac magnetic resonance (CMR) prior to initial AF ablation in the Johns Hopkins Hospital were enrolled. The AF database was reviewed to identify prevalent and incident documented typical AFL. Feature tracking CMR analysis during sinus rhythm was utilized to quantify RA longitudinal strain and strain rate, as well as RA passive and active emptying fractions derived from phasic RA volumes. Results: A total of 115 patients were analyzed (mean age 59.1 ± 11.4 years, 78.3% male, 74.8% paroxysmal AF). Of all patients, 30 (26.1%) had typical AFL. Clinical characteristics and AF type did not differ among groups defined by the absence or presence of typical AFL. In contrast, RA longitudinal strain (41.6 ± 16.8% vs. 55.8 ± 17.1%, p ≤ 0.001), systolic strain rate (1.71 ± 0.85 s−1 vs. 2.33 ± 0.93 s−1, p = 0.002), and late diastolic strain rate (1.78 ± 1.02 s−1 vs. 2.50 ± 0.91 s−1p ≤ 0.001) were significantly lower in patients with typical AFL. Although RA passive emptying fraction was similar among groups (18.9 ± 8.1 vs. 19.5 ± 8.0, p = 0.75), RA active emptying fraction was lower in patients with typical AFL (34.8 ± 12.3 vs. 40.8 ± 12.1, p = 0.02). Conclusions: The reservoir and pump function of the RA is significantly reduced in patients with typical AFL. Prophylactic CTI ablation warrants further study as adjunctive therapy to AF catheter ablation in selected patients with RA dysfunction.
AB - Background: Typical atrial flutter (AFL) often occurs in patients with atrial fibrillation (AF). Decision-making tools for application of prophylactic cavo-tricuspid isthmus (CTI) ablation at the time of AF ablation may improve outcomes. In this study, we sought to define the right atrial (RA) functional characteristics of AF patients with documented typical AFL. Methods: Consecutive patients that underwent cardiac magnetic resonance (CMR) prior to initial AF ablation in the Johns Hopkins Hospital were enrolled. The AF database was reviewed to identify prevalent and incident documented typical AFL. Feature tracking CMR analysis during sinus rhythm was utilized to quantify RA longitudinal strain and strain rate, as well as RA passive and active emptying fractions derived from phasic RA volumes. Results: A total of 115 patients were analyzed (mean age 59.1 ± 11.4 years, 78.3% male, 74.8% paroxysmal AF). Of all patients, 30 (26.1%) had typical AFL. Clinical characteristics and AF type did not differ among groups defined by the absence or presence of typical AFL. In contrast, RA longitudinal strain (41.6 ± 16.8% vs. 55.8 ± 17.1%, p ≤ 0.001), systolic strain rate (1.71 ± 0.85 s−1 vs. 2.33 ± 0.93 s−1, p = 0.002), and late diastolic strain rate (1.78 ± 1.02 s−1 vs. 2.50 ± 0.91 s−1p ≤ 0.001) were significantly lower in patients with typical AFL. Although RA passive emptying fraction was similar among groups (18.9 ± 8.1 vs. 19.5 ± 8.0, p = 0.75), RA active emptying fraction was lower in patients with typical AFL (34.8 ± 12.3 vs. 40.8 ± 12.1, p = 0.02). Conclusions: The reservoir and pump function of the RA is significantly reduced in patients with typical AFL. Prophylactic CTI ablation warrants further study as adjunctive therapy to AF catheter ablation in selected patients with RA dysfunction.
KW - Atrial fibrillation
KW - Atrial flutter
KW - Cardiac magnetic resonance
KW - Pulmonary vein isolation
KW - Right atrium
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U2 - 10.1007/s10840-019-00636-6
DO - 10.1007/s10840-019-00636-6
M3 - Article
C2 - 31807985
AN - SCOPUS:85076217951
SN - 1383-875X
VL - 59
SP - 381
EP - 391
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -