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The electroanatomical remodelling of the left atrium is related to CHADS2/CHA2DS2VASc score and events of stroke in patients with atrial fibrillation

 Jae Hyung Park  ;  Boyoung Joung  ;  Nak-Hoon Son  ;  Jae Min Shim  ;  Moon Hyung Lee  ;  Chun Hwang  ;  Hui-Nam Pak 
 EUROPACE, Vol.13(11) : 1541-1549, 2011 
Journal Title
Issue Date
Adult ; Aged ; Atrial Fibrillation/complications* ; Atrial Fibrillation/surgery* ; Catheter Ablation* ; Echocardiography ; Electrophysiologic Techniques, Cardiac ; Electrophysiological Phenomena/physiology* ; Female ; Heart Atria/diagnostic imaging ; Heart Atria/pathology* ; Heart Atria/physiopathology* ; Humans ; Incidence ; Male ; Middle Aged ; Organ Size ; Risk Factors ; Stroke/epidemiology* ; Tomography, Spiral Computed
BACKGROUND: Although atrial fibrillation (AF) increases the risk of stroke, its relationship with atrial remodelling has not yet been studied. We hypothesized that the degree of electroanatomical remodelling of the left atrium (LA) is related to CHADS₂/CHA₂DS₂VASc score and events of stroke. METHODS AND RESULTS: We compared CHADS₂/CHA₂DS₂VASc score (0, 1, ≥ 2) or events of stroke with mean and regional LA volume [by three-dimensional (3D) computed tomography images] or LA endocardial voltage (by 3D-electroanatomical map) in 348 patients who underwent catheter ablation of AF (78.4% male, 55.4 ± 11.0 years old, paroxysmal AF:persistent AF = 215:133). We graded LA volume index as Grade 1 (< 48.3 mL/m²; n= 80), grade 2 (48.3-63.0 mL/m², n= 82), grade 3 (63.0-99.0 mL/m²; n= 94), and grade 4 (≥ 99.0 mL/m²; n= 92). Results (i) The percentage volume of anterior portion of LA enlarged at the early stage of LA remodelling (Grade 1 vs. grade 2, P= 0.006) and the voltage of posterior venous LA was significantly reduced with the degree of LA remodelling (P= 0.001). (ii) Mean LA volume/body surface area (BSA), especially anterior portion of LA, was greater in patients with high CHADS₂/CHA₂DS₂VASc score (P= 0.002). Mean LA voltage was significantly lower in patients with high CHA₂DS₂VASc score than low score (P= 0.007). (iii) In patients who experience stroke (n= 22), LA volume/BSA, especially anterior LA, was greater (P= 0.012), and LA endocardial voltage was lower (P= 0.039) than those without stroke. CONCLUSION: Electroanatomical remodelling of LA, estimated by LA volume and endocardial voltage, has significant relationship with the risk scores or events of stroke in patients with non-valvular AF.
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1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Son, Nak Hoon(손낙훈)
Shim, Jae Min(심재민)
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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