The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation.

Abstract

OBJECTIVES:

The extent of left atrial (LA) wall structural remodeling (fibrosis) detected by late gadolinium enhancement-magnetic resonance imaging (LGE-MRI) is correlated with advanced atrial fibrillation (AF). The concomitant occurrence of AF and left ventricular (LV) dysfunction is not uncommon. We studied the effect of LA fibrosis, a confounder of both AF and LV dysfunction, on LV ejection fraction (EF).

STUDY DESIGN:

For the analysis, we identified and included 384 patients from our retrospective AF database who underwent LGE-MRI and transthoracic echocardiography prior to AF ablation. Based on the degree of LA fibrosis, patients were categorized into four stages as: Utah 1 (<5% LA fibrosis), Utah 2 (5-20% fibrosis), Utah 3 (20-35% fibrosis), and Utah 4 (>35% fibrosis).

RESULTS:

The average pre-ablation LVEF was 60.5%±8.5% (n=24) in Utah stage 1 patients, 55.7%±10.3% (n=240) in Utah stage 2 patients, 51.7±11.5% (n=90) in Utah stage 3 patients, and 48.9%±11.6% (n=30) in Utah stage 4 patients (p<0.001, one-way ANOVA). The percentage of LA fibrosis was significantly negatively correlated to LVEF pre-ablation in a univariate analysis (p<0.001). In a multivariate model accounting for age, gender, AF type, and comorbidities such as diabetes and hypertension, Utah stage remained a significant predictor of pre-ablation EF (p<0.001).

CONCLUSION:

Patients with extensive LA fibrosis appear to have depressed LV function pre-ablation, suggesting that structural remodeling in the LA may also be triggering and promoting remodeling within the ventricular myocardium.

• Authors: Mehmet Akkaya, Nassir Marrouche, Koji Higuchi, Matthias Koopmann, Kavitha Damal, Eugene Kholmovski, Chris McGann
• Journal: Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir (Turk Kardiyol Dern Ars) Vol. 42 Issue 1 Pg. 11-9 (Jan 2014) ISSN: 1016-5169 [Print] Turkey
• PMID: 24481089 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Atrial Fibrillation (epidemiology, physiopathology)
• Atrial Function, Left (physiology)
• Atrial Remodeling (physiology)
• Female
• Heart Septum (physiology)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stroke Volume (physiology)