Tissue velocity imaging-based atrial fibrillatory cycle length and wall motion for predicting atrial structural remodeling in patients undergoing catheter ablation.
BACKGROUND
Atrial fibrillation (AF) causes atrial electrical and structural remodeling, which are linked to recurrence of AF after ablation. Atrial fibrillatory cycle length (AFCL) and AF wall motion velocity (AFW-V) obtained by tissue velocity imaging (TVI) might characterize such atrial electrical and structural remodeling. The purpose of this study was to assess the clinical and electrophysiologic correlates of these parameters and their relation to ablation outcomes.


RESULTS
The study group comprised 80 patients who underwent transthoracic echocardiography followed by AF ablation. Atrial TVI traces were used to determine AFCL-tvi and AFW-V-tvi at the left atrial septal wall. AFCL that was measured from intracardiac electrograms correlated well with AFCL-tvi (R=0.6094; P=0.0002). AFW-V-tvi was significantly lower and AFCL-tvi was significantly shorter in patients with non-paroxysmal AF than in those with paroxysmal AF (1.63±0.76 cm/s vs. 2.85±1.00 cm/s, respectively, P<0.0001; and 118.2±23.0 ms vs. 145.0±35.0 ms, respectively, P=0.0001). These findings held true for patients with and without post-ablation recurrence. Upon multivariate analysis, a reduced AFW-V-tvi remained the strongest predictor of post-ablation recurrence (hazard ratio for +1-cm/s change, 0.573; 95% confidence interval, 0.337-0.930; P=0.0234).


CONCLUSIONS
TVI of atrial fibrillatory wall motion might enhance the non-invasive characterization of atrial remodeling in patients with AF and thus be used for predicting AF recurrence after ablation.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
Kazumasa
K
Sonoda
Yasuo
Y
Okumura
Ichiro
I
Watanabe
Koichi
K
Nagashima
Masayoshi
M
Kofune
Hiroaki
H
Mano
Rikitake
R
Kogawa
Naoko
N
Sasaki
Kimie
K
Ohkubo
Toshiko
T
Nakai
Atsushi
A
Hirayama
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged