Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation

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• 作者：Esra Gucuk Ipek ; MD^* ; Joseph E. Marine ; MD ; FHRS^* ; Mohammadali Habibi ; MD^* ; Jonathan Chrispin ; MD^* ; Joao Lima ; MD^* ; Jack Rickard ; MD^* ; David Spragg ; MD ; FHRS^* ; Stefan L. Zimmerman ; MD^&dagger ; ; Vadim Zipunnikov ; PhD^&Dagger ; ; Ronald Berger ; MD ; PhD ; FHRS^* ; Hugh Calkins ; MD ; FHRS^* ; Saman Nazarian ; MD ; PhD ; FHRS^* ; ^§ ; ; ^{snazarian@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AF ; atrial fibrillation ; CFAE ; complex fractionated atrial electrogram ; CMR ; cardiac magnetic resonance ; IQR ; interquartile range ; LA ; left atrium/atrial ; LAFL ; left-sided atrial flutter ; LGE ; late gadolinium enhancement ; PLAS ; peak longitudinal left atrial strain ; PVI ; pulmonary vein isolation ; SR-ed ; peak early diastolic left atrial strain rate ; SR-ld ; peak late diastolic left atrial strain rate ; SR-s ; systolic left atrial strain rate
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：13
• 期：2
• 页码：391-398
• 全文大小：1281 K

文摘

Symptomatic left atrial (LA) flutter (LAFL) is common after atrial fibrillation (AF) ablation.

Objective

The purpose of this study was to examine the association of baseline LA function with incident LAFL after AF ablation.

Methods

The source cohort included 216 patients with cardiac magnetic resonance (CMR) before initial AF ablation between 2010 and 2013. Patients who underwent cryoballoon or laser ablation, patients with AF during CMR, and those with suboptimal CMR, or missing follow-up data were excluded. Baseline LA volume and function were assessed by feature-tracking CMR analysis.

Results

The final cohort included 119 patients (mean age 58.9 ± 11 years; 76.5% men; 70.6% patients with paroxysmal AF). During a median follow-up of 421 days (interquartile range 235–751 days), 22 patients (18.5%) had incident LAFL. Baseline LA volume was similar between the 2 groups. In contrast, baseline reservoir, conduit, and contractile function of the LA were significantly impaired in patients with incident LAFL. Baseline global peak longitudinal atrial strain (PLAS) <22.65% predicted incident LAFL with 86% sensitivity and 68% specificity (C statistic 0.76). In a multivariable model adjusting for age, heart failure, and LA volume, PLAS (hazard ratio 0.9 per % increase in PLAS; P = .003) and LA linear lesions (hazard ratio 2.94; P = .020) were independently associated with incident LAFL. The coexistence of PLAS <22.65% and linear lesions was associated with 9-fold increased hazard of incident LAFL.

Conclusion

Baseline LA function and linear lesions were independently associated with incident LAFL after AF ablation. Linear lesions should be limited to selected cases, especially in patients with impaired LA function.