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Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes.

Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes.
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Nedios S, Koutalas E, Sommer P, Arya A, Rolf S, Husser D, Bollmann A, Hindricks G, Breithardt OA,


Nedios S, Koutalas E, Sommer P, Arya A, Rolf S, Husser D, Bollmann A, Hindricks G, Breithardt OA, (click to view)

Nedios S, Koutalas E, Sommer P, Arya A, Rolf S, Husser D, Bollmann A, Hindricks G, Breithardt OA,

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Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2016 Oct 12() pii

Abstract
AIMS
The association between anatomical left atrial (LA) remodelling and ventricular diastolic dysfunction (DD) in atrial fibrillation (AF) patients is not well studied. We aimed to examine the effect of DD on anatomic LA remodelling and their relation with ablation outcomes.

METHODS AND RESULTS
In 104 patients (58 ± 10 years, 69% male) referred for AF ablation, LA volume (LAV) was determined by computed tomography. A cutting plane, between the pulmonary vein (PV) ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA parts. The ratio of LA-A and LAV was defined as the LA asymmetry index (ASI). According to the current guidelines, the presence of DD was evaluated by echocardiography. Regression analysis was used to identify predictors of asymmetry changes and long-term success. Univariate linear regression revealed that ASI is associated with LAV, the presence of DD, and mitral regurgitation. Asymmetry index was higher in patients with DD (n = 35, 62 ± 5 vs. 59 ± 6%, P = 0.013) or mitral regurgitation (n = 67, 61 ± 6 vs. 58 ± 5%, P = 0.025). Multiple linear regression analysis showed that DD (B = 2.6, β = 0.207, 95% confidence interval, CI: 0.167-5.011, P = 0.036) and LAV (B = 0.037, β = 0.211, 95% CI: 0.003-0.071, P = 0.033) were the only factors independently associated with ASI (adjusted r(2) = 0.92, F = 6.2, P = 0.003). Regression analysis showed that AF recurrence (33% after 24 months) is associated with asymmetric LA changes, while DD is not.

CONCLUSIONS
Left atrial symmetry changes are associated with DD and dilatation. Since DD could cause LA remodelling, appropriate early treatment should be considered for AF patients with DD, before geometrical changes occur.

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