Structural Remodeling and Rotational Activity in Persistent/Long-Lasting Atrial Fibrillation: Gender-Effect Differences and Impact on Post-ablation Outcome
Loading...
Full text at PDC
Publication date
2022
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Frontiers Media
Citations
Exportar
Citation
Ríos-Muñoz GR, Soto N, Ávila P, Carta A, Atienza F, Datino T, González-Torrecilla E, Fernández-Avilés F, Arenal Á. Structural Remodeling and Rotational Activity in Persistent/Long-Lasting Atrial Fibrillation: Gender-Effect Differences and Impact on Post-ablation Outcome. Front Cardiovasc Med. 2022 Mar 21;9:819429. doi: 10.3389/fcvm.2022.819429
Abstract
La fibrilación auricular protagoniza una autentica epidemia arrítmica en la actualidad. Las recurrencias y reingresos post-ablacion de fibrilación auricular son superiores en mujeres. Analizamos en 85 pacientes consecutives las diferencias asociadas al sexo en el remodelado estructural y mecanismos de la fibrilación auricular persistente/larga evolución que fueron sometidos a ablación de venas pulmonares en nuestro Centro. Se utilizó tecnología de densidad ultraelevada de puntos para cartografía intra-atrial izquierda, identificándose la actividad rotacional con Sistema CartoFinder y análisis de secuencia de activación. Se analizó el impacto de la localización de la actividad rotacional en los resultados postablación.
Se detectó actividad rotacional en el 73.4% de varones y 38.1% de mujeres (p=0.003), con un menor voltaje endocárdico en estas últimas. Se registro actividad rotacional en la aurícula izquierda posterior en pocas mujeres (23.8% vs. 55% en varones) y la recurrencia de fibrilación auricular fue más elevada en pacientes con rotores fuera de los antros de venas pulmonares ablacionados o sin rotores identificados (63.4%, vs 11,.1 y 31%; p=0.008, y 0.01, respectivamente). Concluimos que las mujeres muestran un remodelado estructural más avanzado en la ablación, que se asocia con una menor incidencia de rotores -en general, fuera de los antros ablacionados-. Ello podría explicar diferencias en la evolución tras la ablación asociadas al sexo en este sustrato.
Background: Structural and post-ablation gender differences are reported in atrial fibrillation (AF). We analyzed the gender differences in structural remodeling and AF mechanisms in patients with persistent/long-lasting AF who underwent wide area circumferential pulmonary vein isolation (WACPVI). Materials and methods: Ultra-high-density mapping was used to study atrial remodeling and AF drivers in 85 consecutive patients. Focal and rotational activity (RAc) were identified with the CartoFinder system and activation sequence analysis. The impact of RAc location on post-ablation outcomes was analyzed. Results: This study included 64 men and 21 women. RAc was detected in 73.4% of men and 38.1% of women (p = 0.003). RAc patients had higher left atrium (LA) voltage (0.64 ± 0.3 vs. 0.50 ± 0.2 mV; p = 0.01), RAc sites had higher voltage than non-RAc sites 0.77 ± 0.46 vs. 0.53 ± 0.37 mV (p < 0.001). Women had lower LA voltage than men (0.42 vs. 0.64 mV; p < 0.001), including pulmonary vein (PV) antra (0.16 vs. 0.30 mV; p < 0.001) and posterior wall (0.34 vs. 0.51 mV; p < 0.001). RAc in the posterior atrium was recorded in few women (23.8 vs. 54.7% in men; p = 0.014). AF recurrence rate was higher in patients with RAc outside WACPVI than those with all RAc inside WACPVI or no RAc (63.4 vs. 11.1 and 31.0%; p = 0.008 and p = 0.01). Comparison of selected patients using propensity score matching confirmed lower atrial voltage (0.4 ± 0.2 vs. 0.7 ± 0.3 mV; p = 0.007) and less RAc (38 vs. 75%; p = 0.02) in women. Conclusion: Women have shown more advanced structural remodeling at ablation, which is associated with a lower incidence of RAc (usually located outside the WACPVI). These findings could explain post-ablation gender differences.
Background: Structural and post-ablation gender differences are reported in atrial fibrillation (AF). We analyzed the gender differences in structural remodeling and AF mechanisms in patients with persistent/long-lasting AF who underwent wide area circumferential pulmonary vein isolation (WACPVI). Materials and methods: Ultra-high-density mapping was used to study atrial remodeling and AF drivers in 85 consecutive patients. Focal and rotational activity (RAc) were identified with the CartoFinder system and activation sequence analysis. The impact of RAc location on post-ablation outcomes was analyzed. Results: This study included 64 men and 21 women. RAc was detected in 73.4% of men and 38.1% of women (p = 0.003). RAc patients had higher left atrium (LA) voltage (0.64 ± 0.3 vs. 0.50 ± 0.2 mV; p = 0.01), RAc sites had higher voltage than non-RAc sites 0.77 ± 0.46 vs. 0.53 ± 0.37 mV (p < 0.001). Women had lower LA voltage than men (0.42 vs. 0.64 mV; p < 0.001), including pulmonary vein (PV) antra (0.16 vs. 0.30 mV; p < 0.001) and posterior wall (0.34 vs. 0.51 mV; p < 0.001). RAc in the posterior atrium was recorded in few women (23.8 vs. 54.7% in men; p = 0.014). AF recurrence rate was higher in patients with RAc outside WACPVI than those with all RAc inside WACPVI or no RAc (63.4 vs. 11.1 and 31.0%; p = 0.008 and p = 0.01). Comparison of selected patients using propensity score matching confirmed lower atrial voltage (0.4 ± 0.2 vs. 0.7 ± 0.3 mV; p = 0.007) and less RAc (38 vs. 75%; p = 0.02) in women. Conclusion: Women have shown more advanced structural remodeling at ablation, which is associated with a lower incidence of RAc (usually located outside the WACPVI). These findings could explain post-ablation gender differences.