Cardiac magnetic resonance-derived right atrial functional analysis in patients with atrial fibrillation and typical atr
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Cardiac magnetic resonance-derived right atrial functional analysis in patients with atrial fibrillation and typical atrial flutter Esra Gucuk Ipek 1,2 Saman Nazarian 1,4
&
Mohammadali Habibi 1 & Tarek Zghaib 1 & Stefan L. Zimmerman 3 & Hugh Calkins 1 & Joao Lima 1 &
Received: 6 April 2019 / Accepted: 25 September 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Typical atrial flutter (AFL) often occurs in patients with atrial fibrillation (AF). Decision-making tools for application of prophylactic cavo-tricuspid isthmus (CTI) ablation at the time of AF ablation may improve outcomes. In this study, we sought to define the right atrial (RA) functional characteristics of AF patients with documented typical AFL. Methods Consecutive patients that underwent cardiac magnetic resonance (CMR) prior to initial AF ablation in the Johns Hopkins Hospital were enrolled. The AF database was reviewed to identify prevalent and incident documented typical AFL. Feature tracking CMR analysis during sinus rhythm was utilized to quantify RA longitudinal strain and strain rate, as well as RA passive and active emptying fractions derived from phasic RA volumes. Results A total of 115 patients were analyzed (mean age 59.1 ± 11.4 years, 78.3% male, 74.8% paroxysmal AF). Of all patients, 30 (26.1%) had typical AFL. Clinical characteristics and AF type did not differ among groups defined by the absence or presence of typical AFL. In contrast, RA longitudinal strain (41.6 ± 16.8% vs. 55.8 ± 17.1%, p ≤ 0.001), systolic strain rate (1.71 ± 0.85 s−1 vs. 2.33 ± 0.93 s−1, p = 0.002), and late diastolic strain rate (1.78 ± 1.02 s−1 vs. 2.50 ± 0.91 s−1 p ≤ 0.001) were significantly lower in patients with typical AFL. Although RA passive emptying fraction was similar among groups (18.9 ± 8.1 vs. 19.5 ± 8.0, p = 0.75), RA active emptying fraction was lower in patients with typical AFL (34.8 ± 12.3 vs. 40.8 ± 12.1, p = 0.02). Conclusions The reservoir and pump function of the RA is significantly reduced in patients with typical AFL. Prophylactic CTI ablation warrants further study as adjunctive therapy to AF catheter ablation in selected patients with RA dysfunction. Keywords Atrial fibrillation . Atrial flutter . Cardiac magnetic resonance . Pulmonary vein isolation . Right atrium
Abbreviations AF Atrial fibrillation AFL Atrial flutter Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-019-00636-6) contains supplementary material, which is available to authorized users. * Esra Gucuk Ipek [email protected] 1
Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
2
Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
3
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
4
Department of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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