Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
Por:
Muller-Edenborn, B, Moreno-Weidmann, Z, Venier, S, Defaye, P, Park, CI, Guerra, J, Alonso-Martin, C, Bazan, V, Vinolas, X, Rodriguez-Font, E, Garcia, BC, Boveda, S, Combes, S, Albenque, JP, Guy-Moyat, B, Trenk, D, Eichenlaub, M, Chen, J, Lehrmann, H, Neumann, FJ, Arentz, T, Jadidi, A
Publicada:
1 sep 2022
Ahead of Print:
1 dic 2021
Resumen:
Aims Despite advances in interventional treatment strategies, atrial fibrillation (AF) remains associated with significant morbidity and mortality. Fibrotic atrial myopathy (FAM) is a main factor for adverse outcomes of AF-ablation, but complex to diagnose using current methods. We aimed to derive a scoring system based entirely on easily available clinical parameters to predict FAM and ablation-success in everyday care.
Methods In this multicenter, prospective study, a new risk stratification model termed AF-SCORE was derived in 220 patients undergoing high-density left-atrial(LA) voltage-mapping to quantify FAM. AF-SCORE was validated for FAM in an external mapping-validation cohort (n = 220) and for success following pulmonary vein isolation (PVI)-only (without adjunctive left- or right atrial ablations) in an external outcome-validation cohort (n = 518).
Results FAM was rare in patients < 60 years (5.4%), but increased with ageing and affected 40.4% (59/146) of patients >= 60 years. Sex and AF-phenotype had additional predictive value in older patients and remained associated with FAM in multivariate models (odds ratio [OR] 6.194, p < 0.0001 for > 60 years; OR 2.863, p < 0.0001 for female sex; OR 41.309, p < 0.0001 for AF-persistency). Additional clinical or diagnostic variables did not improve the model. AF-SCORE (+1 point for age >= 60 years and additional points for female sex [+1] and AF-persistency [+2]) showed good discrimination to detect FAM (c-statistic 0.792) and predicted arrhythmia-freedom following PVI (74.3%, 54.7% and 45.5% for AF-SCORE <= 2, 3 and 4, respectively, and hazard ratio [HR] 1.994 for AF-SCORE = 3 and HR 2.866 for AF-SCORE = 4, p < 0 .001).
Conclusions Age, sex and AF-phenotype are the main determinants for the development of FAM. A low AF-SCORE <= 2 is found in paroxysmal AF-patients of any age and younger patients with persistent AF irrespective of sex, and associated with favorable outcomes of PVI-only. Freedom from arrhythmia remains unsatisfactory with AF-SCORE >= 3 as found in older patients, particularly females, with persistent AF, and future studies investigating adjunctive atrial ablations to PVI-only should focus on these groups of patients.
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Filiaciones:
Muller-Edenborn, B:
Univ Freiburg, Sect Electrophysiol, Heart Ctr, Dept Cardiol & Angiol 2, Sudring 15, D-79189 Bad Krozingen, Germany
Julius Hosp, Dept Cardiol, Wurzburg, Germany
Moreno-Weidmann, Z:
Univ Freiburg, Sect Electrophysiol, Heart Ctr, Dept Cardiol & Angiol 2, Sudring 15, D-79189 Bad Krozingen, Germany
Univ Autonoma Barcelona, Dept Electrophysiol, CIBERCV, Hosp Santa Creu & St Pau, Barcelona, Spain
Venier, S:
Univ Hosp Grenoble, Dept Cardiol, Grenoble, France
Defaye, P:
Univ Hosp Grenoble, Dept Cardiol, Grenoble, France
Park, CI:
Clin Tour, Dept Cardiol, Geneva, Switzerland
Guerra, J:
Univ Autonoma Barcelona, Dept Electrophysiol, CIBERCV, Hosp Santa Creu & St Pau, Barcelona, Spain
Alonso-Martin, C:
Univ Autonoma Barcelona, Dept Electrophysiol, CIBERCV, Hosp Santa Creu & St Pau, Barcelona, Spain
Bazan, V:
Univ Autonoma Barcelona, Dept Electrophysiol, CIBERCV, Hosp Santa Creu & St Pau, Barcelona, Spain
Vinolas, X:
Univ Autonoma Barcelona, Dept Electrophysiol, CIBERCV, Hosp Santa Creu & St Pau, Barcelona, Spain
Rodriguez-Font, E:
Univ Autonoma Barcelona, Dept Electrophysiol, CIBERCV, Hosp Santa Creu & St Pau, Barcelona, Spain
Garcia, BC:
Univ Autonoma Barcelona, Dept Electrophysiol, CIBERCV, Hosp Santa Creu & St Pau, Barcelona, Spain
Boveda, S:
Clin Pasteur, Heart Rhythm Management Dept, Toulouse, France
Combes, S:
Clin Pasteur, Heart Rhythm Management Dept, Toulouse, France
Albenque, JP:
Clin Pasteur, Heart Rhythm Management Dept, Toulouse, France
Guy-Moyat, B:
Univ Hosp Limoges, Dept Cardiol, Limoges, France
Trenk, D:
Univ Freiburg, Heart Ctr, Dept Cardiol & Angiol 2, Sect Pharmacol, Bad Krozingen, Germany
Eichenlaub, M:
Univ Freiburg, Sect Electrophysiol, Heart Ctr, Dept Cardiol & Angiol 2, Sudring 15, D-79189 Bad Krozingen, Germany
Chen, J:
Univ Hosp Mainz, Dept Electrophysiol, Mainz, Germany
Lehrmann, H:
Univ Freiburg, Sect Electrophysiol, Heart Ctr, Dept Cardiol & Angiol 2, Sudring 15, D-79189 Bad Krozingen, Germany
Neumann, FJ:
Univ Freiburg, Heart Ctr, Dept Cardiol & Angiol 2, Bad Krozingen, Germany
Arentz, T:
Univ Freiburg, Sect Electrophysiol, Heart Ctr, Dept Cardiol & Angiol 2, Sudring 15, D-79189 Bad Krozingen, Germany
Jadidi, A:
Univ Freiburg, Sect Electrophysiol, Heart Ctr, Dept Cardiol & Angiol 2, Sudring 15, D-79189 Bad Krozingen, Germany
hybrid, All Open Access, Hybrid Gold
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