N 4 (185) 2023. P. 69–74

THE ROLE OF CARDIAC STRUCTURAL REMODELING UNDER ATRIAL FIBRILLATION: IMAGING BASICS FOR PREDICTING RECURRENCE (LITERATURE REVIEW)

Odesa National Medical University, Odesa, Ukraine

DOI https://doi.org/10.32782/2226-2008-2023-4-14

Atrial fibrillation (AF) is arrhythmia characterized by supraventricular rhythm disturbance, with chaotic electrical activity of the atria, the progression of which is associated with an increased risk of stroke and heart failure. It adversely affects the quality of life and prognosis and increases the level of hospitalization and mortality. Radiofrequency ablation of AF is the most effective method of treating patients with arrhythmias.

The most important predictor of progression and recurrence of AF is the structural and electromechanical remodeling of the atria, which occurs due to the arrhythmia itself, contributes to its progression, and develops tachy-induced cardiomyopathy.

The increased automaticity and trigger activity that occurs in the atria during structural remodeling can cause difficulties in maintaining sinus rhythm after ablation.

The most common method for assessing fibrous structural remodeling of the left ventricle is two- (2D) or three-dimensional (3D) echocardiography (EchoCG), involving measuring the size and volume of the left atrium (LV) or its function, as well as the degree of deformation via speckle tracking Echo-CG. The use of a set of indicators of the contractile function of the myocardium opens up the prospects of a personalized study of the compensatory capabilities of the heart and the choice of treatment tactics.

Thus, we can conclude that the severity of AF fibrosis is associated with the size and functionality of the heart chambers and plays an important role in the development of AF recurrences. Echocardiography is one of the main non-invasive research methods for detecting the presence of atriomegaly, assessing the degree of fibrosis, and settling the issue of the further choice of AF treatment tactics.

Key words: atrial fibrillation, recurrences, echocardiography, left atrium.

REFERENCES

  1. Abduch MC, Alencar AM, Mathias Jr W, et Cardiac mechanics evaluated by speckle tracking echocardiography. Arq Bras Cardiol. 2014;102(4):403–12. doi: 10.5935/abc.20140041.
  2. Aparina OP, Stukalova OV, Parkhomenko DV, et al. Structural and Functional Properties of the Left Atrium in Healthy Volunteers and Patients With Atrial Fibrillation: Data of Magnetic Resonance Imaging. Kardiologiia. 2018;57(9):5-13. doi: 18087/cardio.2017.9.10029.
  3. Asad Z, Abbas M, Javed I, Korantzopoulos P, Stavrakis Obesity is associated with incident atrial fibrillation independent of gender: a meta-analysis. J Cardiovasc Electrophysiol. 2018;29(5):725-732. doi: 10.1111/jce.13458.
  4. Baumgartner C, da Costa BR, Collet TH, et al. Thyroid Studies Collaboration. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation. 2017;136 (22):2100-2116. doi: 10.1161/ CIRCULATIONAHA.117.028753.
  5. Bax JJ, Marsan NA, Delgado V. Non-invasive imaging in atrial fibrillation: focus on prognosis and catheter ablation. Heart. 2015;101(2):94-100. doi: 1136/heartjnl-2013-305150.
  6. Blomstrom-Lundqvist C, Gizurarson S, Schwieler J, et al. Effect of catheter ablation vs antiarrhythmic medication on quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial. JAMA. 2019;321(11):1059-1068. doi: 1001/jama.2019.0335.
  7. Bossard M, Knecht S, Aeschbacher S, et al. Conventional versus 3-D Echocardiography to Predict Arrhythmia Recurrence After Atrial Fibrillation J Cardiovasc Electrophysiol. 2017;28(6):651-658. doi: 10.1111/jce.13202.
  8. Ceornodolea AD, Bal R, Severens JL. Epidemiology and management of atrial fibrillation and stroke: review of data from four European Stroke Res Treat. 2017;2017:8593207. doi: 10.1155/2017/8593207.
  9. Chen F, Sun Q, Li H, et al. Value of dual Doppler echocardiography for prediction of atrial fibrillation recurrence after radiofrequency catheter BMC Cardiovasc Disord. 2019;19(1):257. doi: 10.1186/s12872-019-1233-x.
  10. Costa FM, Ferreira AM, Oliveira S, et Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation. Int J Cardiol. 2015;184:56-61. doi: 10.1016/j.ijcard.2015.01.060.
  11. Çöteli C, Hazırolan T, Aytemir K, et Evaluation of atrial fibrosis in atrial fibrillation patients with three different methods. Turk J Med Sci. 2022;52(1):175-187. doi: 10.3906/sag-2103-194.
  12. Donal E, Lip GY, Galderisi M, et al. EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016;17(4):355-83. doi: 10.1093/ehjci/
  13. Fornengo C, Antolini M, Frea S, et Prediction of atrial fibrillation recurrence after cardioversion in patients with left-atrial dilation. Eur Heart J Cardiovasc Imaging. 2015;16(3):335-41. doi: 10.1093/ehjci/jeu193.
  14. Hakalahti A, Biancari F, Nielsen JC, Raatikainen Radiofrequency ablation vs. antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis. Europace. 2015;17(3):370-378. doi: 10.1093/europace/euu376.
  15. He Y, Zhang B, Zhu F, Hu Z, Zhong J, Zhu Transesophageal echocardiography measures left atrial appendage volume and function and predicts recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2018;35(7):985-990. doi: 10.1111/echo.13856.
  16. Hobbelt AH, Siland JE, Geelhoed B, et Clinical, biomarker, and genetic predictors of specific types of atrial fibrillation in a community-based cohort: data of the PREVEND study. Europace. 2017;19(2):226-232. doi: 10.1093/europace/euw016.
  17. Hongning Y, Ruiqin X, Jing W, et al. Assessment of left atrial function and dyssynchrony by real time three-dimensional echocardiography predicts recurrence of paroxysmal atrial fibrillation after radiofrequency Eur Rev Med Pharmacol Sci. 2018;22(10):3151-3159. doi: 10.26355/eurrev_201805_15075.
  18. Hori Y, Nakahara S, Fukuda R, et Atrial reverse remodeling represented by the atrial conduction time in persistent atrial fibrillation patients after catheter ablation: its impact on predicting late atrial fibrillation recurrence. J Cardiol. 2020;75(5):521-528. doi: 10.1016/j.jjcc.2019.09.018.
  19. Kalam K, Otahal P, Marwick Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100(21):1673–80. doi: 10.1136/heartjnl-2014-305538.
  20. Karantoumanis I, Doundoulakis I, Zafeiropoulos S, et al. Atrial conduction time associated predictors of recurrent atrial Int J Cardiovasc Imaging. 2021;37(4):1267-1277. doi: 10.1007/s10554-020-02113-y.
  21. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with Eur Heart J. 2016;37(38):2893-2962. doi: 10.1093/eurheartj/ehw210.
  22. Knecht S, Pradella M, Reichlin T, et al. Left atrial anatomy, atrial fibrillation burden, and P-wave duration-relationships and predictors for single-procedure success after pulmonary vein isolation. Europace. 2018;20(2):271-278. doi: 10.1093/ europace/euw376.
  23. Kosiuk J, Dinov B, Kornej J, et al. Prospective, multicenter validation of a clinical risk score for left atrial arrhythmogenic substrate based on voltage analysis: DR-FLASH score. Heart Rhythm. 2015;12(11):2207-2212. doi: 10.1016/j. 2015.07.003.
  24. Kranert M, Shchetynska-Marinova T, Liebe V, et al. Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume In Vivo. 2020;34(2):889-896. doi: 10.21873/invivo.11854.
  25. Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, Drelich L, Królak T, Raczak G. Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review. Cardiol J. 2020;27(6):848-856. doi: 10.5603/ a2018.0067.
  26. Ma J, Chen Q, Ma Left atrial fibrosis in atrial fibrillation: Mechanisms, clinical evaluation and management. J Cell Mol Med. 2021;25(6):2764-2775. doi: 10.1111/jcmm.16350.
  27. Ma XX, Boldt LH, Zhang YL, et Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta-Analysis Echocardiography. 2016;33(5):724-33. doi: 10.1111/echo.13184.
  28. Mark DB, Anstrom KJ, Sheng S, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical JAMA. 2019;321(13):1275-1285. doi: 10.1001/jama.2019.0692.
  29. Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF JAMA. 2014;311(5):498-506. doi: 10.1001/jama.2014.3.
  30. Mochizuki A, Yuda S, Fujito T, et al. Left atrial strain assessed by three-dimensional speckle tracking echocardiography predicts atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. J Echocardiogr. 2017;15(2):79-87. doi: 1007/s12574-017-0329-5.
  31. Mohanty S, Della Rocca DJ, Gianni C, et Predictors of recurrent atrial fibrillation following catheter ablation. Expert Rev Cardiovasc Ther. 2021;19(3):237-246. doi: 10.1080/14779072.2021.1892490.
  32. Montserrat S, Gabrielli L, Borras R, et al. Left atrial size and function by three-dimensional echocardiography to predict arrhythmia recurrence after first and repeated ablation of atrial fibrillation. Eur Heart JCardiovasc Imaging. 2014;15(5):515-22. doi: 1093/ehjci/jet194.
  33. Mourik MJ, Arita VA, Lyon A, et Association between comorbidities and left and right atrial dysfunction in patients with paroxysmal atrial fibrillation: Analysis of AF-RISK. Int J Cardiol. 2022;360:29-35. doi: 10.1016/j.ijcard.2022.05.044.
  34. Nakashima T, Kawasaki M, Toyoshi H, et al. Impact of the pulmonary vein orifice area assessed using intracardiac echocardiography on the outcome of radiofrequency catheter ablation for atrial J Interv Card Electrophysiol. 20 18;51(2):133-142. doi: 10.1007/s10840-018-0324-4.
  35. Nery PB, Belliveau D, Nair GM, et Relationship between pulmonary vein reconnection and atrial fibrillation recurrence: a systematic review and meta-analysis. JACC: Clin Electrophysiol. 2016;2:474-483. doi: 10.1016/j.jacep.2016.02.003.
  36. Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace. 2018;20(1):33-42. doi: 1093/europace/eux013.
  37. Nyong J, Amit G, Adler AJ, et al. Efficacy and safety of ablation for people with nonparoxysmal atrial fibrillation. Cochrane Database Syst Rev. 2016;11 (11):CD012088. doi: 1002/14651858.CD012088.pub2.
  38. Qiu D, Peng L, Ghista DN, Wong KK. Left Atrial Remodeling Mechanisms Associated with Atrial Fibrillation. Cardiovasc Eng Technol. 2021;12(3):361-372. doi: 1007/s13239-021-00527-w.
  39. Quah JX, Dharmaprani D, Tiver K, et al. Atrial fibrosis and substrate based characterization in atrial fibrillation: Time to move J Cardiovasc Electrophysiol. 2021;32(4):1147-1160. doi: 10.1111/jce.14987.
  40. Raymond-Paquin A, Nattel S, Wakili R, Tadros R. Mechanisms and clinical significance of arrhythmia-induced Can J Cardiol. 2018;34 (11):1449-1460. doi: 10.1016/j.cjca.2018.07.475.
  41. Reil JC, Tauchnitz M, Tian Q, et Hyperaldosteronism induces left atrial systolic and diastolic dysfunction. Am J Physiol Heart Circ Physiol. 2016;311:H1014-H1023. doi:10.1152/ajpheart.00261.2016.
  42. Sgreccia D, Manicardi M, Malavasi VL, et al. Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients. J Clin Med. 2021;10(17): doi: 10.3390/jcm10173979.
  43. Shi LZ, Heng R, Liu SM, Leng FY. Effect of catheter ablation versus antiarrhythmic drugs on atrial fibrillation: a meta- analysis of randomized controlled Exp Ther Med. 2015;10(2):816-822. doi: 10.3892/etm.2015.2545.
  44. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res. 2017; 120(9):1501-1517. doi: 10.1161/CIRCRESAHA.117.309732.
  45. Svensson T, Kitlinski M, Engstrom G, Melander O. Psychological stress and risk of incident atrial fibrillation in men and women with known atrial fibrillation genetic risk Sci Rep. 2017;7:42613. doi: 10.1038/srep42613.
  46. Ukita K, Egami Y, Kawamura A, et al. Impact of radiofrequency catheter ablation for atrial fibrillation in patients with left atrial Heart Vessels. 2022;37(11):1899-1905. doi: 10.1007/s00380-022-02094-z.
  47. Walfridsson H, Walfridsson U, Nielsen JC, et Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial. Europace. 2015;17(2):215-221. doi: 10.1093/europace/euu342.
  48. Wen SN, Liu N, Bai R, et Right atrial diameter and outcome of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 2017;49(2):157-164. doi: 10.1007/s10840-017-0258-2.
  49. Williams SE, O’Neill L, Roney CH, et al. Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial J Cardiovasc Electrophysiol. 2019;30(9):1416-1427. DOI: 10.1111/ jce.13990.
  50. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi: 10.1111/ echo.15670.