Evaluation of shortness of breath after atrial fibrillation ablation-Is there a stiff left atrium?

Published on Jun 1, 2018in Heart Rhythm5.731
· DOI :10.1016/J.HRTHM.2018.01.029
Yogesh N.V. Reddy26
Estimated H-index: 26
(Mayo Clinic),
Abdallah El Sabbagh13
Estimated H-index: 13
(Mayo Clinic)
+ 1 AuthorsRick A. Nishimura128
Estimated H-index: 128
(Mayo Clinic)
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Abstract
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References11
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#1Pranav Chandrashekar (Mayo Clinic)H-Index: 5
#2Jae Yoon Park (Mayo Clinic)H-Index: 7
Last. Barry A. Borlaug (Mayo Clinic)H-Index: 76
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Radiofrequency ablation is an effective therapy to restore sinus rhythm in patients with symptomatic atrial fibrillation. Approximately 1.4% of patients undergoing ablation develop unexplained dyspnea because of isolated left atrial (LA) hypertension.1,2 This condition has been termed the stiff LA syndrome. Ideal treatment strategies for stiff LA syndrome remain unclear. A 71-year-old man presented with dyspnea. He had a history of paroxysmal atrial fibrillation/flutter treated with 3 ablation p...
8 CitationsSource
#1Rowlens M. Melduni (Mayo Clinic)H-Index: 11
#2Hartzell V. Schaff (Mayo Clinic)H-Index: 131
Last. Samuel J. Asirvatham (Mayo Clinic)H-Index: 57
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Background: Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. Methods: Of 10 633 adults who underwent coronary artery bypass grafting and valve surgery between January 2000 and December 2005, 9792 patients with complete baseline characteristics, surgery procedure, and follow-up data were included in this analysis. A propensity scor...
63 CitationsSource
#1Irfan M. Khurram (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 13
#2Farhan Maqbool (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 4
Last. Stefan L. ZimmermanH-Index: 32
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Background— Atrial fibrillation (AF) is associated with significant abnormalities of left atrial (LA) systolic and diastolic function. This study describes a novel measure, LA stiffness index, that estimates LA diastolic function and its association with clinical outcomes of catheter ablation. Methods and Results— A total of 219 AF patients referred for ablation (59% paroxysmal, mean CHA2DS2VASc score 1.7±1.4) were enrolled. Atrial pressure and volume loops were prepared from invasive pressure m...
35 CitationsSource
#1Atul Verma (McMaster University)H-Index: 8
#1Atul Verma (McMaster University)H-Index: 2
Last. Prashanthan SandersH-Index: 102
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BackgroundCatheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation. Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial fibrillation. MethodsWe randomly assigned 589 patients with persistent atrial fibrillation in a 1:4:4 ratio to ablation with pulmonary-vein isolation alone (67 patients), pulmonary-vein isolation plus ablation of electrograms showing complex fracti...
1,053 CitationsSource
#1A. Marc Gillinov (Cleveland Clinic)H-Index: 91
#2Annetine C. Gelijns (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 64
Last. Michael Argenziano (Columbia University)H-Index: 57
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More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 9...
214 CitationsSource
#1Nassir F. Marrouche (UofU: University of Utah)H-Index: 63
#2David J. Wilber (Loyola University Medical Center)H-Index: 50
Last. Johannes BrachmannH-Index: 58
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Importance Left atrial fibrosis is prominent in patients with atrial fibrillation (AF). Extensive atrial tissue fibrosis identified by delayed enhancement magnetic resonance imaging (MRI) has been associated with poor outcomes of AF catheter ablation. Objective To characterize the feasibility of atrial tissue fibrosis estimation by delayed enhancement MRI and its association with subsequent AF ablation outcome. Design, Setting, and Participants Multicenter, prospective, observational cohort stud...
669 CitationsSource
#1Terrence D. Welch (Dartmouth–Hitchcock Medical Center)H-Index: 5
#2Megan CoylewrightH-Index: 11
Last. Rick A. NishimuraH-Index: 128
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Background The surgical maze procedure is highly effective in treating symptomatic atrial fibrillation but may have detrimental effects on left atrial (LA) contractile function and compliance. Objective To describe a series of patients presenting with symptomatic pulmonary hypertension due in part to LA dysfunction after surgical maze procedures. Methods This report includes 9 patients who (1) presented to Mayo Clinic (Rochester, MN) between 2008 and 2012 with unexplained dyspnea and pulmonary h...
14 CitationsSource
#1Douglas Gibson (Scripps Health)H-Index: 13
#2Luigi Di Biase (University of Texas at Austin)H-Index: 77
Last. Andrea NataleH-Index: 118
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Background There have been no studies of atrial diastolic function after catheter ablation of atrial fibrillation (AF). We encountered a few patients with symptomatic left atrial (LA) diastolic dysfunction and associated pulmonary hypertension (PH) that developed after catheter ablation for atrial fibrillation. Similar findings were described in patients after cardiac surgery and were referred to as the "stiff left atrial syndrome." Objective The purpose of this study was to prospectively quanti...
122 CitationsSource
#1Otto A. SmisethH-Index: 70
#2Christopher R. Thompson (St. Paul's Hospital)H-Index: 67
Last. John B. Bowering (St. Paul's Hospital)H-Index: 7
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OBJECTIVES The purpose of this study was to determine the origin of the pulmonary venous systolic flow pulse using wave-intensity analysis to separate forward- and backward-going waves. BACKGROUND The mechanism of the pulmonary venous systolic flow pulse is unclear and could be a “suction effect” due to a fall in atrial pressure (backward-going wave) or a “pushing effect” due to forward-propagation of right ventricular (RV) pressure (forward-going wave). METHODS In eight patients during coronary...
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#1Tomotsugu Tabata (University of Tokushima)H-Index: 29
#2Takashi Oki (University of Tokushima)H-Index: 31
Last. Shuzo Oshita (University of Tokushima)H-Index: 20
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Abstract We evaluated the role of left atrial appendage (LAA) in the left atrial (LA) reservoir function by assessing the changes in LA flow dynamics after LAA clamping during cardiac surgery. The subjects were 8 patients who had undergone coronary artery bypass grafting (CABG) and 7 who had undergone mitral valvular surgery due to mitral regurgitation. We recorded transmitral, pulmonary venous and LAA flow velocity patterns by intraoperative transesophageal pulsed Doppler echocardiography, moni...
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Cited By13
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#1Madeline K. Mahowald (Mayo Clinic)H-Index: 3
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view all 5 authors...
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#1Douglas L. Packer (Mayo Clinic)H-Index: 76
#1Douglas L. PackerH-Index: 26
Last. Daniel B. Mark (Duke University)H-Index: 136
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Background: In patients with heart failure (HF) and atrial fibrillation (AF), several clinical trials have reported improved outcomes, including freedom from AF recurrence, quality of life (QOL), a...
2 CitationsSource
#1Stephen P. Wright (UBC: University of British Columbia)H-Index: 1
#1Stephen P. Wright (UBC: University of British Columbia)H-Index: 1
Last. Susanna Mak (U of T: University of Toronto)H-Index: 20
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With each heartbeat, the right ventricle (RV) inputs blood into the pulmonary vascular (PV) compartment which conducts blood through the lungs at low pressure and concurrently fills the left atrium (LA) for output to the systemic circulation. This overall hemodynamic function of the integrated RV-PV-LA unit is determined by complex interactions between the components that vary over the cardiac cycle but are often assessed in terms of mean pressure and flow. Exercise challenges these hemodynamic ...
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#1Yogesh N.V. Reddy (Mayo Clinic)H-Index: 26
#2Barry A. Borlaug (Mayo Clinic)H-Index: 76
Pulmonary hypertension is common in left heart disease and is related most commonly to passive back transmission of elevated left atrial pressures. Some patients, however, may develop pulmonary vascular remodeling superimposed on their left-sided heart disease. This review provides a contemporary appraisal of existing criteria to diagnose a precapillary component to pulmonary hypertension in left heart disease as well as discusses etiologies, management issues, and future directions.
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#1William R. Miranda (Mayo Clinic)H-Index: 14
#2C. Charles Jain (Mayo Clinic)H-Index: 4
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Objective To assess the prevalence of elevated systemic right ventricular (sRV) end-diastolic pressure and pulmonary arterial hypertension in adults with transposition of the great arteries (TGA) who have undergone atrial switch operation. Methods Forty-two adults (aged ≥18 years) with complete TGA and atrial switch palliation undergoing cardiac catheterisation between 2004 and 2018 at Mayo Clinic, MN, were identified. Clinical, echocardiographic and invasive haemodynamic data were abstracted fr...
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#1Masaru Obokata (Mayo Clinic)H-Index: 22
#2Yogesh N.V. Reddy (Mayo Clinic)H-Index: 26
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Abstract Research in the last decade has substantially advanced our understanding of the pathophysiology of heart failure with preserved ejection fraction (HFpEF). However, treatment options remain limited as clinical trials have largely failed to identify effective therapies. Part of this failure may be related to mechanistic heterogeneity. It is speculated that categorizing HFpEF patients based upon underlying pathophysiological phenotypes may represent the key next step in delivering the righ...
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#1Christopher Selleck (Cleveland Clinic)
#2Thomas NoelH-Index: 5
Last. Wayne B. BatchelorH-Index: 5
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Abstract Scarring from atrial ablation carries a risk of developing stiff left atrium syndrome, which can mimic mitral valve disease. We present a case of a 73-year-old man whose stiff left atrium syndrome came to light after percutaneous mitral valve repair. (Level of Difficulty: Intermediate.)
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#1Inki Moon (Seoul National University Hospital)H-Index: 6
#2Seo Young Lee (Seoul National University Hospital)H-Index: 5
Last. Seil Oh (Seoul National University Hospital)H-Index: 29
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INTRODUCTION: The left atrium (LA), including the pulmonary vein antrum, is the main target of catheter ablation for atrial fibrillation (AF). However, there is a lack of data on the effect of extensive LA ablation on LA stiffness. This study sought to investigate the impact of extensive LA ablation on LA stiffness and dyspnea after the restoration of sinus rhythm. METHODS: In total, 97 patients with AF (80 patients who only underwent pulmonary vein isolation [PVI] and 17 patients who underwent ...
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