Yonsei Med J.  2017 Mar;58(2):282-289. 10.3349/ymj.2017.58.2.282.

A Thin Left Atrial Antral Wall Around the Pulmonary Vein Reflects Structural Remodeling by Atrial Fibrillation and is Associated with Stroke

• Park J
• Park CH
• Uhm JS
• Pak HN
• Lee MH
• Joung B

• KMID: 2427115
• DOI: http://doi.org/10.3349/ymj.2017.58.2.282

Abstract

PURPOSE
Circumferential pulmonary (PV) vein isolation (CPVI) is the most important treatment strategy for atrial fibrillation (AF). While understanding left atrial wall thickness around PVs (PVWT) prior to catheter ablation is important, its clinical implications are not known. This study aimed to evaluate PVWT characteristics according to underlying disease and to identify associations between PVWT and reconnections of PV potentials (PVPs) in redo ablation.
MATERIALS AND METHODS
In 28 patients who underwent redo-AF ablation, PVWT and reconnected PVPs were evaluated at 12 sites (1-12 o'clock) around each PV. Clinical characteristics including stroke and CHAâ‚‚DSâ‚‚-VASc scores were analyzed according to the PVWT.
RESULTS
The PVWT was thicker in males than females (p<0.001) and in those with diabetes (p=0.045) or heart failure (p=0.002) than in those without. Patients with strokes or high CHA₂DS₂-VASc scores (≥3) had significantly thinner PVWTs than those without strokes or low CHA₂DS₂-VASc scores (p<0.001). In redo-ablation, reconnected PVPs were detected in 60 (53.6%) of 112 PVs, and the PVs were thicker (p<0.001) and had more reconnected PVs (p=0.009) than right PVs. A PVWT of >0.6 mm predicted PV reconnections with a sensitivity of 76.7% and specificity of 52.2% with an area under the curve of 0.695.
CONCLUSION
Thick PVWs were associated with diabetes and heart failure, and also showed significant inverse correlations with stroke and the CHAâ‚‚DSâ‚‚-VASc score. Thick PVWs were associated with reconnected PVPs after the CPVI, which were related to AF recurrence.

Keyword

Pulmonary vein; wall thickness; ablation; stroke; reconnection

MeSH Terms

Aged
Atrial Fibrillation/diagnosis/*physiopathology/*surgery
Catheter Ablation/adverse effects/*methods
Female
Heart Atria/physiopathology
Humans
Male
Middle Aged
Pulmonary Veins/*physiopathology/*surgery
Recurrence
Reproducibility of Results
Sensitivity and Specificity
Stroke/*physiopathology
Treatment Outcome

Figure

• 

  Fig. 1 Measurement of the PVWT (left atrial antral wall thickness around the right superior pulmonary vein). The details are described in the Methods section. (A) oblique axial images, (B) oblique coronary images, (C) true enface view of the target pulmonary vein, (D) the PVWTs are measured carefully at 12 equiangular points (1 o'clock to 12 o'clock sites). PVWT, wall thickness around pulmonary veins.

• 

  Fig. 2 The distribution of the PVWT according to age. The PVW was thickest in those in their mid-fifties and became thinner with increasing age. PVWT, wall thickness around pulmonary veins.

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  Fig. 3 The difference in the PVWT according to the gender (A) and underlying disease, including heart failure (B), hypertension (C), and diabetes (D). *p<0.05. PVWT, wall thickness around pulmonary veins.

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  Fig. 4 The PVWT of the patients with a stroke (A) or high CHA2DS2-VASc score (B) was thinner than that in those without. *p<0.05. PVWT, wall thickness around pulmonary veins.

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  Fig. 5 The PVWT and reconnection of the PV potentials (schematic enface view of each PV from 1 to 12 o'clock). The outer circle (blue) indicates the relative PVWT, and inner circle (orange) the relative ratio of the PV reconnections. The numbers in the parentheses denote the number of PV potentials that were detected at each site. RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein; LSPV, left superior pulmonary vein; LIPV, left inferior pulmonary vein; PVWT, wall thickness around PVs; PV, pulmonary vein.

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  Fig. 6 ROC curve of the PWVT for predicting PV reconnections. ROC, receiver operating characteristic; PVWT, wall thickness around PVs; PV, pulmonary vein.

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