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Adjunctive left anterior line ablation induced left atrial dysfunction and dyssynchrony in atrial fibrillation ablation

  • Hirosuke Yamaji
  • Takashi Murakami
  • Kazuyoshi Hina
  • Shunichi Higashiya
  • Hiroshi Kawamura
  • Masaaki Murakami
  • Shigeshi Kamikawa
  • Satoshi Hirohata
  • Shozo Kusachi
Original Article

Abstract

We evaluated the effects of adjunctive left anterior line (LAL) ablation on LA dyssynchrony and function using real-time three-dimensional echocardiography (3DE) in connection with thromboembolic complications and tachyarrhythmia recurrence in patients with persistent atrial fibrillation (AF). We randomly and prospectively assigned consecutive persistent AF patients to the LAL (n = 52, 65 ± 7 years) and control groups (n = 50, 64 ± 10 years). In the LAL group, extensive encircling pulmonary vein isolation (EEPVI), roof line ablation, and LAL ablation regardless of the extent of the low-voltage area (LVA) were performed. The control group underwent EEPVI and roof line ablation. After ablation, 3DE demonstrated LA dyssynchrony in 23 (46%) and 4 patients (8%, P < 0.001) of the LAL and control groups, respectively. Baseline LA LVAs were relatively small in most patients and there were no significant differences in extent of LVA between control and LAL groups or between patients with and without dyssynchrony. During the follow-up periods (771 ± 121 days), patients with LA dyssynchrony in the LAL group did not show significant differences in symptomatic thromboembolic events (0%) and atrial tachyarrhythmia recurrence (39%) from patients without LA dyssynchrony in the LAL (0% and 30%) and control groups (0% and 32%, respectively). LA ejection fraction and active emptying fraction were lower by 9% on average in the LAL group than in the control group (P < 0.0001). Similarly, in the LAL group, LA ejection fraction, active emptying fraction, and expansion index were significantly lower by approximately 7%, 8%, and 15%, respectively, in LA with dyssynchrony than those in LA without dyssynchrony. In conclusion, LA dyssynchrony and LA hypofunction were induced by LAL ablation in patients with persistent AF and relatively mild LVA. LAL ablation with or without LA dyssynchrony is thought not to affect thromboembolic complications or atrial tachyarrhythmia recurrence.

Keywords

Tachyarrhythmia Catheter ablation Left atrium Real-time three-dimensional echocardiography Complications 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no competing interests.

Supplementary material

380_2018_1238_MOESM1_ESM.mov (1 mb)
Motion images of LA dyssynchrony (+) and (-). MVA, mitral valve annulus (MOV 1046 kb)

References

  1. 1.
    Jiang Z, Yin H, He Y, Ma N, Tang M, Liu H, Ding F, Mei J (2015) Efficacy and safety of novel epicardial circumferential left atrial ablation with pulmonary vein isolation in sustained atrial fibrillation. Heart Vessels 30:675–681CrossRefPubMedGoogle Scholar
  2. 2.
    Haissaguerre M, Hocini M, Sanders P, Sacher F, Rotter M, Takahashi Y, Rostock T, Hsu LF, Bordachar P, Reuter S, Roudaut R, Clementy J, Jais P (2005) Catheter ablation of long-lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol 16:1138–1147CrossRefPubMedGoogle Scholar
  3. 3.
    Tzeis S, Luik A, Jilek C, Schmitt C, Estner HL, Wu J, Reents T, Fichtner S, Kolb C, Karch MR, Hessling G, Deisenhofer I (2010) The modified anterior line: an alternative linear lesion in perimitral flutter. J Cardiovasc Electrophysiol 21:665–670CrossRefPubMedGoogle Scholar
  4. 4.
    Ammar S, Luik A, Hessling G, Bruhm A, Reents T, Semmler V, Buiatti A, Kathan S, Hofmann M, Kolb C, Schmitt C, Deisenhofer I (2015) Ablation of perimitral flutter: acute and long-term success of the modified anterior line. Europace 17:447–452CrossRefPubMedGoogle Scholar
  5. 5.
    (2000) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 284:3043–3045Google Scholar
  6. 6.
    Yamaji H, Murakami T, Hina K, Higashiya S, Kawamura H, Murakami M, Kamikawa S, Komtasubara I, Kusachi S (2016) Adequate initial heparin dosage for atrial fibrillation ablation in patients receiving non-vitamin K antagonist oral anticoagulants. Clin Drug Investig 36:837–848CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Yamaji H, Murakami T, Hina K, Higashiya S, Kawamura H, Murakami M, Kamikawa S, Hirohata S, Kusachi S (2013) Usefulness of dabigatran etexilate as periprocedural anticoagulation therapy for atrial fibrillation ablation. Clin Drug Investig 33:409–418CrossRefPubMedGoogle Scholar
  8. 8.
    Piorkowski C, Eitel C, Rolf S, Bode K, Sommer P, Gaspar T, Kircher S, Wetzel U, Parwani AS, Boldt LH, Mende M, Bollmann A, Husser D, Dagres N, Esato M, Arya A, Haverkamp W, Hindricks G (2011) Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: a prospective, randomized study. Circ Arrhythm Electrophysiol 4:157–165CrossRefPubMedGoogle Scholar
  9. 9.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463CrossRefPubMedGoogle Scholar
  10. 10.
    Marsan NA, Tops LF, Holman ER, Van de Veire NR, Zeppenfeld K, Boersma E, van der Wall EE, Schalij MJ, Bax JJ (2008) Comparison of left atrial volumes and function by real-time three-dimensional echocardiography in patients having catheter ablation for atrial fibrillation with persistence of sinus rhythm versus recurrent atrial fibrillation three months later. Am J Cardiol 102:847–853CrossRefPubMedGoogle Scholar
  11. 11.
    Murata M, Iwanaga S, Tamura Y, Kondo M, Kouyama K, Ogawa S (2008) A real-time three-dimensional echocardiographic quantitative analysis of left atrial function in left ventricular diastolic dysfunction. Am J Cardiol 102:1097–1102CrossRefPubMedGoogle Scholar
  12. 12.
    Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE (2009) Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-time three-dimensional echocardiography. Eur J Echocardiogr 10:738–744CrossRefPubMedGoogle Scholar
  13. 13.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270CrossRefPubMedGoogle Scholar
  14. 14.
    Anwar AM, Soliman OI, Geleijnse ML, Nemes A, Vletter WB, ten Cate FJ (2008) Assessment of left atrial volume and function by real-time three-dimensional echocardiography. Int J Cardiol 123:155–161CrossRefPubMedGoogle Scholar
  15. 15.
    Schwartzman D, Ren JF, Devine WA, Callans DJ (2001) Cardiac swelling associated with linear radiofrequency ablation in the atrium. J Interv Card Electrophysiol 5:159–166CrossRefPubMedGoogle Scholar
  16. 16.
    Okada T, Yamada T, Murakami Y, Yoshida N, Ninomiya Y, Shimizu T, Toyama J, Yoshida Y, Ito T, Tsuboi N, Kondo T, Inden Y, Hirai M, Murohara T (2007) Prevalence and severity of left atrial edema detected by electron beam tomography early after pulmonary vein ablation. J Am Coll Cardiol 49:1436–1442CrossRefPubMedGoogle Scholar
  17. 17.
    Verma N, Knight BP (2017) What happens during the blanking period does not stay in the blanking period. J Cardiovasc Electrophysiol 28:634–635CrossRefPubMedGoogle Scholar
  18. 18.
    Alipour P, Azizi Z, Pirbaglou M, Ritvo P, Pantano A, Verma A, Khaykin Y (2017) Defining blanking period post pulmonary vein antrum isolation. JACC Clin Electrophysiol 3:568–576CrossRefPubMedGoogle Scholar
  19. 19.
    Jenkins C, Bricknell K, Chan J, Hanekom L, Marwick TH (2007) Comparison of two- and three-dimensional echocardiography with sequential magnetic resonance imaging for evaluating left ventricular volume and ejection fraction over time in patients with healed myocardial infarction. Am J Cardiol 99:300–306CrossRefPubMedGoogle Scholar
  20. 20.
    Grimm RA, Stewart WJ, Arheart K, Thomas JD, Klein AL (1997) Left atrial appendage “stunning” after electrical cardioversion of atrial flutter: an attenuated response compared with atrial fibrillation as the mechanism for lower susceptibility to thromboembolic events. J Am Coll Cardiol 29:582–589CrossRefPubMedGoogle Scholar
  21. 21.
    Ellis K, Ziada KM, Vivekananthan D, Latif AA, Shaaraoui M, Martin D, Grimm RA (2006) Transthoracic echocardiographic predictors of left atrial appendage thrombus. Am J Cardiol 97:421–425CrossRefPubMedGoogle Scholar
  22. 22.
    Santiago D, Warshofsky M, Li Mandri G, Di Tullio M, Coromilas J, Reiffel J, Homma S (1994) Left atrial appendage function and thrombus formation in atrial fibrillation-flutter: a transesophageal echocardiographic study. J Am Coll Cardiol 24:159–164CrossRefPubMedGoogle Scholar
  23. 23.
    Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, Lellouche N, Knecht S, Wright M, Nault I, Miyazaki S, Scavee C, Clementy J, Haissaguerre M, Jais P (2011) Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol 57:160–166CrossRefPubMedGoogle Scholar
  24. 24.
    Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P (2015) Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812–1822CrossRefPubMedGoogle Scholar
  25. 25.
    Wong KC, Paisey JR, Sopher M, Balasubramaniam R, Jones M, Qureshi N, Hayes CR, Ginks MR, Rajappan K, Bashir Y, Betts TR (2015) No benefit of complex fractionated atrial electrogram ablation in addition to circumferential pulmonary vein ablation and linear ablation: benefit of complex ablation study. Circ Arrhythm Electrophysiol 8:1316–1324PubMedGoogle Scholar
  26. 26.
    Rolf S, Kircher S, Arya A, Eitel C, Sommer P, Richter S, Gaspar T, Bollmann A, Altmann D, Piedra C, Hindricks G, Piorkowski C (2014) Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol 7:825–833CrossRefPubMedGoogle Scholar
  27. 27.
    Jadidi AS, Lehrmann H, Keyl C, Sorrel J, Markstein V, Minners J, Park CI, Denis A, Jais P, Hocini M, Potocnik C, Allgeier J, Hochholzer W, Herrera-Sidloky C, Kim S, Omri YE, Neumann FJ, Weber R, Haissaguerre M, Arentz T (2016) Ablation of persistent atrial fibrillation targeting low-voltage areas with selective activation characteristics. Circ Arrhythm Electrophysiol 9:e002962CrossRefPubMedGoogle Scholar
  28. 28.
    Yagishita A, Gimbel JR, De Oliveira S, Manyam H, Sparano D, Cakulev I, Mackall J, Arruda M (2017) Long-term outcome of left atrial voltage-guided substrate ablation during atrial fibrillation: a novel adjunctive ablation strategy. J Cardiovasc Electrophysiol 28:147–155CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Hirosuke Yamaji
    • 1
  • Takashi Murakami
    • 1
  • Kazuyoshi Hina
    • 1
  • Shunichi Higashiya
    • 1
  • Hiroshi Kawamura
    • 1
  • Masaaki Murakami
    • 1
  • Shigeshi Kamikawa
    • 1
  • Satoshi Hirohata
    • 1
  • Shozo Kusachi
    • 1
    • 2
  1. 1.Heart Rhythm CenterOkayama Heart ClinicOkayamaJapan
  2. 2.Department of Medical TechnologyOkayama University Graduate School of Health SciencesOkayamaJapan

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