title: Investigation of the atrial conduction time measured by tissue Doppler imaging at the left atrial appendage and the actual electrical conduction time: consideration of left atrial remodeling in atrial fibrillation patients.
abstract: OBJECTIVE
  The atrial conduction time measured by echocardiography using tissue Doppler imaging (TDI) has been reported as a predictive factor of left atrial (LA) remodeling. We investigated the P wave to LA appendage (LAA) conduction time defined by transthoracic echocardiography using TDI (P-LAA TDI), and directly compared the actual LA electrical conduction time determined by the electrophysiological data. Additionally, we confirmed the clinical utility of the P-LAA TDI by examining the relationship to the electroanatomical LA remodeling data.
  
  
  METHODS
  Sixty-three AF patients (22 paroxysmal AF, 41 persistent AF) underwent ablation and electroanatomical LA mapping. The P-LAA TDI was measured after the ablation and was compared with the electrophysiological data during sinus rhythm, including the actual electrical conduction time.
  
  
  RESULTS
  A strong linear correlation (r = 0.776, p < 0.001, y = 1.28x + 49) was observed between the P-LAA TDI (161 ± 24 ms) and electrophysiological P-LAA time (87 ± 15 ms). The P-LAA TDI was also strongly correlated with the LA volume (173 ± 52 ml, r = 0.632, p < 0.001) and LA conduction velocity index (1.07 ± 0.19 mm/ms, r = -0.735, p < 0.001), but less to the focal anterior-LVA region surface area (2.2 [0.4-5.0] cm2, r = 0.380, p = 0.002). Additionally, a stepwise multiple linear regression demonstrated that both the LA volume and LA conduction velocity index were strongly associated with the value of the P-LAA TDI (p < 0.001).
  
  
  CONCLUSIONS
  The P-LAA TDI was useful for estimating the actual electrophysiological conduction time and represented both electrical and anatomical LA remodeling.
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555. yuichi-h@dokkyomed.ac.jp.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakahara
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Anjo
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Kouta
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Akiko
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Komatsu
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Sayuki
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, Japan, 343-8555.
authors.forename: Isao
authors.initials: I
authors.lastname: Taguchi
mesh_terms: D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016275:Atrial Function; D064752:Atrial Remodeling; D018780:Body Surface Potential Mapping / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D056966:Excitation Contraction Coupling; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Ablation; Atrial conduction time; Atrial fibrillation; Left atrial remodeling