Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy

Long-Term Follow-Up of CAMERA-MRI Study

Hariharan Sugumar, Sandeep Prabhu, Aleksandr Voskoboinik, Shane Young, Sarah J. Gutman, Geoffrey R. Wong, Ramanathan Parameswaran, Chrishan J. Nalliah, Geoff Lee, Alex J. McLellan, Andrew J. Taylor, Liang Han Ling, Jonathan M. Kalman, Peter M. Kistler

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Objectives: This study sought to determine the long-term right atrial (RA) electrical and structural changes in a subgroup from the CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction-Magnetic Resonance Imaging) study. Background: Catheter ablation (CA) is successful in restoring ventricular function in patients with atrial fibrillation (AF) and otherwise unexplained cardiomyopathy, as demonstrated in the randomized study of CA versus rate control (CAMERA-MRI). It is unknown if this is associated with atrial remodeling. Methods: Detailed electroanatomical (EA) mapping of the RA using CARTO3 and a force sensing catheter was performed at initial CA and electively at least 12 months after CA in patients with >90% reduction in AF burden following ablation. Bipolar voltage, fractionation, and conduction velocity were collected in 4 segments together with echo and cardiac magnetic resonance imaging. Results: Fifteen patients (mean age 59.1 ± 6.8 years) underwent repeat RA EA mapping. At a mean follow-up of 23.4 ± 11.9 months, left ventricular (LV) ejection fraction improved from 33.6 ± 3.2% to 54.1 ± 3.2% (p = 0.001), RA area decreased from 28.4 ± 2.0 cm2 to 20.8 ± 1.2 cm2 (p < 0.001), and left atrial area decreased from 32.9 ± 2.3 cm2 to 26.8 ± 1.4 cm2 (p = 0.007). On EA mapping, RA bipolar voltage increased from 1.6 ± 0.1 mV to 1.9 ± 0.1 mV (p = 0.04). Tissue voltage increased across all regions, which achieved statistical significance at the posterior (p = 0.002) and septal (p = 0.01) segments. There was a significant decrease in complex fractionated electrograms from 21.7 ± 3.5% to 8.3 ± 1.8% (p = 0.002); however, no significant change occurred in global or regional conduction velocities (p = 0.5). Conclusions: Recovery of atrial electrical and structural changes was observed following restoration of sinus rhythm and recovery of LV function in patients who underwent CA for persistent AF and LV systolic dysfunction. The randomized CAMERA MRI study demonstrated significant improvement in LV systolic function with AF ablation compared with rate control. The present study demonstrated reverse electrical and structural atrial recovery in concert with recovery of LV systolic function at 2 years post-AF ablation. This may partially explain the long-term success of CA in patients with AF and otherwise unexplained cardiomyopathy.

Original languageEnglish
Pages (from-to)681-688
Number of pages8
JournalJACC: Clinical Electrophysiology
Volume5
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • arrhythmia
  • atrial fibrillation
  • cardiomyopathy
  • reversible
  • tachycardia

Cite this

Sugumar, Hariharan ; Prabhu, Sandeep ; Voskoboinik, Aleksandr ; Young, Shane ; Gutman, Sarah J. ; Wong, Geoffrey R. ; Parameswaran, Ramanathan ; Nalliah, Chrishan J. ; Lee, Geoff ; McLellan, Alex J. ; Taylor, Andrew J. ; Ling, Liang Han ; Kalman, Jonathan M. ; Kistler, Peter M. / Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy : Long-Term Follow-Up of CAMERA-MRI Study. In: JACC: Clinical Electrophysiology. 2019 ; Vol. 5, No. 6. pp. 681-688.
@article{1bf388a7f20c4107b77dd40d73b44918,
title = "Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy: Long-Term Follow-Up of CAMERA-MRI Study",
abstract = "Objectives: This study sought to determine the long-term right atrial (RA) electrical and structural changes in a subgroup from the CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction-Magnetic Resonance Imaging) study. Background: Catheter ablation (CA) is successful in restoring ventricular function in patients with atrial fibrillation (AF) and otherwise unexplained cardiomyopathy, as demonstrated in the randomized study of CA versus rate control (CAMERA-MRI). It is unknown if this is associated with atrial remodeling. Methods: Detailed electroanatomical (EA) mapping of the RA using CARTO3 and a force sensing catheter was performed at initial CA and electively at least 12 months after CA in patients with >90{\%} reduction in AF burden following ablation. Bipolar voltage, fractionation, and conduction velocity were collected in 4 segments together with echo and cardiac magnetic resonance imaging. Results: Fifteen patients (mean age 59.1 ± 6.8 years) underwent repeat RA EA mapping. At a mean follow-up of 23.4 ± 11.9 months, left ventricular (LV) ejection fraction improved from 33.6 ± 3.2{\%} to 54.1 ± 3.2{\%} (p = 0.001), RA area decreased from 28.4 ± 2.0 cm2 to 20.8 ± 1.2 cm2 (p < 0.001), and left atrial area decreased from 32.9 ± 2.3 cm2 to 26.8 ± 1.4 cm2 (p = 0.007). On EA mapping, RA bipolar voltage increased from 1.6 ± 0.1 mV to 1.9 ± 0.1 mV (p = 0.04). Tissue voltage increased across all regions, which achieved statistical significance at the posterior (p = 0.002) and septal (p = 0.01) segments. There was a significant decrease in complex fractionated electrograms from 21.7 ± 3.5{\%} to 8.3 ± 1.8{\%} (p = 0.002); however, no significant change occurred in global or regional conduction velocities (p = 0.5). Conclusions: Recovery of atrial electrical and structural changes was observed following restoration of sinus rhythm and recovery of LV function in patients who underwent CA for persistent AF and LV systolic dysfunction. The randomized CAMERA MRI study demonstrated significant improvement in LV systolic function with AF ablation compared with rate control. The present study demonstrated reverse electrical and structural atrial recovery in concert with recovery of LV systolic function at 2 years post-AF ablation. This may partially explain the long-term success of CA in patients with AF and otherwise unexplained cardiomyopathy.",
keywords = "arrhythmia, atrial fibrillation, cardiomyopathy, reversible, tachycardia",
author = "Hariharan Sugumar and Sandeep Prabhu and Aleksandr Voskoboinik and Shane Young and Gutman, {Sarah J.} and Wong, {Geoffrey R.} and Ramanathan Parameswaran and Nalliah, {Chrishan J.} and Geoff Lee and McLellan, {Alex J.} and Taylor, {Andrew J.} and Ling, {Liang Han} and Kalman, {Jonathan M.} and Kistler, {Peter M.}",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.jacep.2019.03.009",
language = "English",
volume = "5",
pages = "681--688",
journal = "JACC: Clinical Electrophysiology",
issn = "2405-500X",
publisher = "Elsevier",
number = "6",

}

Sugumar, H, Prabhu, S, Voskoboinik, A, Young, S, Gutman, SJ, Wong, GR, Parameswaran, R, Nalliah, CJ, Lee, G, McLellan, AJ, Taylor, AJ, Ling, LH, Kalman, JM & Kistler, PM 2019, 'Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy: Long-Term Follow-Up of CAMERA-MRI Study', JACC: Clinical Electrophysiology, vol. 5, no. 6, pp. 681-688. https://doi.org/10.1016/j.jacep.2019.03.009

Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy : Long-Term Follow-Up of CAMERA-MRI Study. / Sugumar, Hariharan; Prabhu, Sandeep; Voskoboinik, Aleksandr; Young, Shane; Gutman, Sarah J.; Wong, Geoffrey R.; Parameswaran, Ramanathan; Nalliah, Chrishan J.; Lee, Geoff; McLellan, Alex J.; Taylor, Andrew J.; Ling, Liang Han; Kalman, Jonathan M.; Kistler, Peter M.

In: JACC: Clinical Electrophysiology, Vol. 5, No. 6, 01.06.2019, p. 681-688.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Atrial Remodeling Following Catheter Ablation for Atrial Fibrillation-Mediated Cardiomyopathy

T2 - Long-Term Follow-Up of CAMERA-MRI Study

AU - Sugumar, Hariharan

AU - Prabhu, Sandeep

AU - Voskoboinik, Aleksandr

AU - Young, Shane

AU - Gutman, Sarah J.

AU - Wong, Geoffrey R.

AU - Parameswaran, Ramanathan

AU - Nalliah, Chrishan J.

AU - Lee, Geoff

AU - McLellan, Alex J.

AU - Taylor, Andrew J.

AU - Ling, Liang Han

AU - Kalman, Jonathan M.

AU - Kistler, Peter M.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objectives: This study sought to determine the long-term right atrial (RA) electrical and structural changes in a subgroup from the CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction-Magnetic Resonance Imaging) study. Background: Catheter ablation (CA) is successful in restoring ventricular function in patients with atrial fibrillation (AF) and otherwise unexplained cardiomyopathy, as demonstrated in the randomized study of CA versus rate control (CAMERA-MRI). It is unknown if this is associated with atrial remodeling. Methods: Detailed electroanatomical (EA) mapping of the RA using CARTO3 and a force sensing catheter was performed at initial CA and electively at least 12 months after CA in patients with >90% reduction in AF burden following ablation. Bipolar voltage, fractionation, and conduction velocity were collected in 4 segments together with echo and cardiac magnetic resonance imaging. Results: Fifteen patients (mean age 59.1 ± 6.8 years) underwent repeat RA EA mapping. At a mean follow-up of 23.4 ± 11.9 months, left ventricular (LV) ejection fraction improved from 33.6 ± 3.2% to 54.1 ± 3.2% (p = 0.001), RA area decreased from 28.4 ± 2.0 cm2 to 20.8 ± 1.2 cm2 (p < 0.001), and left atrial area decreased from 32.9 ± 2.3 cm2 to 26.8 ± 1.4 cm2 (p = 0.007). On EA mapping, RA bipolar voltage increased from 1.6 ± 0.1 mV to 1.9 ± 0.1 mV (p = 0.04). Tissue voltage increased across all regions, which achieved statistical significance at the posterior (p = 0.002) and septal (p = 0.01) segments. There was a significant decrease in complex fractionated electrograms from 21.7 ± 3.5% to 8.3 ± 1.8% (p = 0.002); however, no significant change occurred in global or regional conduction velocities (p = 0.5). Conclusions: Recovery of atrial electrical and structural changes was observed following restoration of sinus rhythm and recovery of LV function in patients who underwent CA for persistent AF and LV systolic dysfunction. The randomized CAMERA MRI study demonstrated significant improvement in LV systolic function with AF ablation compared with rate control. The present study demonstrated reverse electrical and structural atrial recovery in concert with recovery of LV systolic function at 2 years post-AF ablation. This may partially explain the long-term success of CA in patients with AF and otherwise unexplained cardiomyopathy.

AB - Objectives: This study sought to determine the long-term right atrial (RA) electrical and structural changes in a subgroup from the CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction-Magnetic Resonance Imaging) study. Background: Catheter ablation (CA) is successful in restoring ventricular function in patients with atrial fibrillation (AF) and otherwise unexplained cardiomyopathy, as demonstrated in the randomized study of CA versus rate control (CAMERA-MRI). It is unknown if this is associated with atrial remodeling. Methods: Detailed electroanatomical (EA) mapping of the RA using CARTO3 and a force sensing catheter was performed at initial CA and electively at least 12 months after CA in patients with >90% reduction in AF burden following ablation. Bipolar voltage, fractionation, and conduction velocity were collected in 4 segments together with echo and cardiac magnetic resonance imaging. Results: Fifteen patients (mean age 59.1 ± 6.8 years) underwent repeat RA EA mapping. At a mean follow-up of 23.4 ± 11.9 months, left ventricular (LV) ejection fraction improved from 33.6 ± 3.2% to 54.1 ± 3.2% (p = 0.001), RA area decreased from 28.4 ± 2.0 cm2 to 20.8 ± 1.2 cm2 (p < 0.001), and left atrial area decreased from 32.9 ± 2.3 cm2 to 26.8 ± 1.4 cm2 (p = 0.007). On EA mapping, RA bipolar voltage increased from 1.6 ± 0.1 mV to 1.9 ± 0.1 mV (p = 0.04). Tissue voltage increased across all regions, which achieved statistical significance at the posterior (p = 0.002) and septal (p = 0.01) segments. There was a significant decrease in complex fractionated electrograms from 21.7 ± 3.5% to 8.3 ± 1.8% (p = 0.002); however, no significant change occurred in global or regional conduction velocities (p = 0.5). Conclusions: Recovery of atrial electrical and structural changes was observed following restoration of sinus rhythm and recovery of LV function in patients who underwent CA for persistent AF and LV systolic dysfunction. The randomized CAMERA MRI study demonstrated significant improvement in LV systolic function with AF ablation compared with rate control. The present study demonstrated reverse electrical and structural atrial recovery in concert with recovery of LV systolic function at 2 years post-AF ablation. This may partially explain the long-term success of CA in patients with AF and otherwise unexplained cardiomyopathy.

KW - arrhythmia

KW - atrial fibrillation

KW - cardiomyopathy

KW - reversible

KW - tachycardia

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U2 - 10.1016/j.jacep.2019.03.009

DO - 10.1016/j.jacep.2019.03.009

M3 - Article

VL - 5

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EP - 688

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

SN - 2405-500X

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