Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Guan-Yi Li¹  Chi-Ting Lu¹  Yu-Shan Huang¹  Yoon Kee Siow²  Shang-Ju Wu³  Dat Cao Tran⁴  Ting-Yung Chang⁵  Fa-Po Chung⁵  Tze-Fan Chao⁵  Yenn-Jiang Lin⁵  Li-Wei Lo⁵  Jo-Nan Liao⁵  Shin-Huei Liu⁵  Ling Kuo⁵  Chih-Min Liu⁵  Chin-Yu Lin⁵  Yu-Feng Hu⁵  Shih-Lin Chang⁵  Ta-Chuan Tuan⁵  Cheng-I Wu⁵  Ming-Jen Kuo⁶  Shih-Ann Chen⁷  Ngoc Nguyen Dinh Son⁸  Jose Antonio L. Bautista⁹ 

[1] Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Department of Cardiology, Serdang Hospital, Selangor, Malaysia;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Department of Cardiology, Taichung Veterans General Hospital, Taichung City, Taiwan;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan;Department of Cardiology, Taichung Veterans General Hospital, Taichung City, Taiwan;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan;Department of Cardiology, Taichung Veterans General Hospital, Taichung City, Taiwan;Department of Medicine, National Chung Hsing University, Taichung City, Taiwan;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Department of Medicine, University Medical Center, Ho Chi Minh City, Vietnam;Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan;Section of Clinical Cardiac Electrophysiology, Heart Institute, St. Luke’s Medical Center – Global City, Taguig City, Philippines;

关键词: atrial fibrillation;    mitral regurgitation;    substrate;    ablation;    echocardiography atrial fibrillation;    catheter ablation;    scar;   

DOI  :  10.3389/fcvm.2023.1265890

 received in 2023-07-24, accepted in 2023-10-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundAtrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients.MethodsPatients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA.ResultsFifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHA2DS2-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, P = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, P = 0.007) and diabetes mellitus (3.1% vs. 22.2%, P = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, P < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation.ConclusionMost patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.

【 授权许可】

Unknown   
© 2023 Bautista, Lin, Lu, Lo, Lin, Chang, Hu, Chung, Tuan, Chao, Liao, Chang, Kuo, Liu, Liu, Wu, Kuo, Li, Huang, Wu, Siow, Son, Tran and Chen.