Korean J Intern Med.  2015 Nov;30(6):808-820. 10.3904/kjim.2015.30.6.808.

Interatrial septal thickness as a marker of structural and functional remodeling of the left atrium in patients with atrial fibrillation

• Lim HE
• Na JO
• Im SI
• Choi CU
• Kim SH
• Kim JW
• Kim EJ
• Han SW
• Rha SW
• Park CG
• Seo HS
• Oh DJ
• Hwang C

• KMID: 2381585
• DOI: http://doi.org/10.3904/kjim.2015.30.6.808

Abstract

BACKGROUND/AIMS
There have been reports that interatrial septal (IAS) thickness is increased in patients with atrial fibrillation (AF). This study was performed to investigate whether IAS thickness determined by transthoracic echocardiography (TTE) represents the amount of left atrium (LA) structural and functional remodeling.
METHODS
The study population consisted of 104 consecutive patients who underwent catheter ablation (CA) for AF (paroxysmal atrial fibrillation [PAF], 82; persistent atrial fibrillation [PeAF], 22). IAS thickness and left atrium volume (LAV) using TTE, and LA voltage (LAVOL) using 3-dimensional electroanatomical mapping system were assessed during sinus rhythm.
RESULTS
IAS thickness was significantly correlated with maximal LAV (LAVmax) (r = 0.288, p = 0.003), mean LAVOL (r = -0.537, p < 0.001), total left atrium emptying fraction (LAEFtotal; r = -0.213, p = 0.030), and active LAEF (LAEFactive; r = -0.249, p = 0.014). IAS thickness was greater in the high-risk group (> or = 2) compared to other groups according to CHA2DS2-VASc score (p = 0.019). During a follow-up of 19.6 months, 23 subjects (22.1%; PAF, 17; PeAF, 6) had recurrence of arrhythmia. Univariate analysis showed that LAVmax, minimal LAV, mean LAVOL, LVEFtotal, LVEFactive, and IAS thickness were associated with recurrence of arrhythmia. However, on multivariate analysis, only mean LAVOL and LAEFactive were independent risk factors for recurrence.
CONCLUSIONS
Although IAS thickness showed significant correlations with parameters for LA structural and functional remodeling, this parameter alone could not independently predict recurrence of arrhythmia after CA for AF.

Keyword

Atrial fibrillation; Atrial septum; Heart atria; Atrial remodeling

MeSH Terms

Action Potentials
Adult
Aged
Area Under Curve
Atrial Fibrillation/physiopathology/*radiography/surgery/*ultrasonography
*Atrial Function, Left
*Atrial Remodeling
Atrial Septum/physiopathology/*radiography/*ultrasonography
Catheter Ablation
Chi-Square Distribution
*Echocardiography, Doppler
Electrophysiologic Techniques, Cardiac
Female
Humans
Linear Models
Male
Middle Aged
*Multidetector Computed Tomography
Multivariate Analysis
Predictive Value of Tests
Prospective Studies
ROC Curve
Recurrence
Risk Factors
Time Factors
Treatment Outcome