Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
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...
| Authors: | ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; |
|---|---|
| Format: | Article |
| Status: | Published version |
| Publication date: | 2022 |
| Country: | España |
| Institution: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repository: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p5175 |
| Online Access: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5175 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120434139&doi=10.1007%2fs00392-021-01973-1&partnerID=40&md5=6328a7cfa2e9e006028037c2e87a7f86 |
| Access Level: | Open access |
| Keyword: | Atrial fibrillation Risk stratification Pulmonary vein isolation Fibrotic atrial myopathy |
| _version_ | 1878729206072868864 |
|---|---|
| author | Muller-Edenborn, B |
| author2 | 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 |
| author2_role | author author author author author author author author author author author author author author author author author author author author author |
| author_browse | Albenque, JP Alonso-Martin, C Arentz, T Bazan, V Boveda, S Chen, J Combes, S Defaye, P Eichenlaub, M Garcia, BC Guerra, J Guy-Moyat, B Jadidi, A Lehrmann, H Moreno-Weidmann, Z Muller-Edenborn, B Neumann, FJ Park, CI Rodriguez-Font, E Trenk, D Venier, S Vinolas, X |
| author_facet | 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 |
| author_role | author |
| collection | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| description | 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. [GRAPHICS] . |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_0366246345fef70427cf2858ca5ea238 |
| institution | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| instname_str | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:iibsantpau.fundanetsuite.com:p5175 |
| publishDate | 2022 |
| publishDateSort | 2022 |
| publisher | SPRINGER HEIDELBERG |
| publisherStr | SPRINGER HEIDELBERG |
| reponame_str | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| spelling | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group 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 Atrial fibrillation Risk stratification Pulmonary vein isolation Fibrotic atrial myopathy 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. [GRAPHICS] . SPRINGER HEIDELBERG https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5175 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120434139&doi=10.1007%2fs00392-021-01973-1&partnerID=40&md5=6328a7cfa2e9e006028037c2e87a7f86 |
| spellingShingle | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group Muller-Edenborn, B Atrial fibrillation Risk stratification Pulmonary vein isolation Fibrotic atrial myopathy |
| status_str | publishedVersion |
| title | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group |
| title_full | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group |
| title_fullStr | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group |
| title_full_unstemmed | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group |
| title_short | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group |
| title_sort | Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group |
| topic | Atrial fibrillation Risk stratification Pulmonary vein isolation Fibrotic atrial myopathy |
| topic_facet | Atrial fibrillation Risk stratification Pulmonary vein isolation Fibrotic atrial myopathy |
| url | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5175 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120434139&doi=10.1007%2fs00392-021-01973-1&partnerID=40&md5=6328a7cfa2e9e006028037c2e87a7f86 |