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Association Between Plaque Thickness of the Thoracic Aorta and Recurrence of Atrial Fibrillation After Ablation

  • Hwang, Hui-Jeong (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Lee, Man-Young (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Youn, Ho-Joong (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Oh, Yong-Seog (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Rho, Tae-Ho (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Chung, Wook-Sung (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Park, Chul-Soo (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Choi, Yun-Seok (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Chung, Woo-Baek (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jae-Beom (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Park, Hyun-Keun (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Lim, Keun-Joon (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jae-Hak (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • Published : 2011.04.30

Abstract

Background and Objectives: Several predictors of recurrence of atrial fibrillation (AF) after ablation have been identified, including age, type of AF, hypertension, left atrial diameter and impaired left ventricular ejection fraction. The aim of this study was to investigate whether the atherosclerotic plaque thickness of the thoracic aorta is associated with a recurrence of AF after circumferential pulmonary vein ablation (CPVA). Subjects and Methods: Among patients with drug-refractory paroxysmal or persistent AF, 105 consecutive (mean age 58${\pm}$11 years, male : female=76 : 29) patients who underwent transesophageal echocardiography and CPVA were studied. The relationships between the recurrence of AF and variables, including clinical characteristics, plaque thickness of the thoracic aorta, laboratory findings and echocardiographic parameters were evaluated. Results: A univariate analysis showed that the presence of diabetes {hazard ratio (HR)=3.425; 95% confidence interval (CI), 1.422-8.249, p=0.006}, ischemic heart disease (HR=4.549; 95% CI, 1.679-12.322, p=0.003), duration of AF (HR=1.010; 95% CI, 1.001-1.018, p=0.025), type of AF (HR=2.412, 95% CI=1.042-5.584, p=0.040) and aortic plaque thickness with ${\geq}$4 mm (HR=9.514; 95% CI, 3.419-26.105, p<0.001) were significantly associated with the recurrence of AF after ablation. In Cox multivariate regression analysis, only the aortic plaque thickness (with ${\geq}$4 mm) was an independent predictor of recurrence of AF after ablation (HR=7.250, 95% CI=1.906-27.580, p=0.004). Conclusion: Significantly increased aortic plaque thickness can be a predictable marker of recurrence of AF after CPVA.

Keywords

References

  1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22: 983-8. https://doi.org/10.1161/01.STR.22.8.983
  2. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946-52. https://doi.org/10.1161/01.CIR.98.10.946
  3. Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibr-illation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 2003;107:2920-5. https://doi.org/10.1161/01.CIR.0000072767.89944.6E
  4. Lee KS, Choi SJ, Park SH, Kim HL, Min H, Park HY. Prevalence of atrial fibrillation in middle-aged people in Korea: the Korean genome and epidemiology study. Korean Circ J 2008;38:601-5. https://doi.org/10.4070/kcj.2008.38.11.601
  5. Sauer WH, McKernan ML, Lin D, Gerstenfeld EP, Callans DJ, Mar-chlinski FE. Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation. Heart Rhythm 2006;3:1024-8. https://doi.org/10.1016/j.hrthm.2006.05.007
  6. Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Pre-valence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med 1995;155:469-73. https://doi.org/10.1001/archinte.1995.00430050045005
  7. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study. JAMA 1994;271: 840-4. https://doi.org/10.1001/jama.1994.03510350050036
  8. Berruezo A, Tamborero D, Mont L, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J 2007;28:836-41. https://doi.org/10.1093/eurheartj/ehm027
  9. Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and He-alth Study. Am J Med 2005;118:489-95. https://doi.org/10.1016/j.amjmed.2005.01.031
  10. Goto S, Bhatt DL, Rother J, et al. Prevalence, clinical profile, and car-diovascular outcomes of atrial fibrillation patients with atherothrombosis. Am Heart J 2008;156:855-63. https://doi.org/10.1016/j.ahj.2008.06.029
  11. Heeringa J, van der Kuip DA, Hofman A, et al. Subclinical atherosclerosis and risk of atrial fibrillation. Arch Intern Med 2007;167: 382-7. https://doi.org/10.1001/archinte.167.4.382
  12. Blackshear JL, Pearce LA, Hart RG, et al. Aortic plaque in atrial fibrillation: prevalence, predictors, and thromboembolic implications. Stroke 1999;30:834-40. https://doi.org/10.1161/01.STR.30.4.834
  13. Agmon Y, Khandheria BK, Meissner I, et al. Association of atrial fibrillation and aortic atherosclerosis: a population-based study. Mayo Clin Proc 2001;76:252-9. https://doi.org/10.4065/76.3.252
  14. De Potter T, Berruezo A, Mont L, et al. Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation abl-ation. Europace 2010;12:24-9. https://doi.org/10.1093/europace/eup309
  15. Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the me-thods, efficacy, and safety of catheter ablation for human atrial fibrill-ation. Circulation 2005;111:1100-5. https://doi.org/10.1161/01.CIR.0000157153.30978.67
  16. Chen MS, Marrouche NF, Khaykin Y, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systo-lic function. J Am Coll Cardiol 2004;43:1004-9. https://doi.org/10.1016/j.jacc.2003.09.056
  17. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guide lines for the management of patients with atrial fibrillation. Circulation 2006;114:e257-354. https://doi.org/10.1161/CIRCULATIONAHA.106.177292
  18. Calvo N, Mont L, Tamborero D, et al. Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes. Europace 2010;12:30-6. https://doi.org/10.1093/europace/eup320
  19. Natale A, Raviele A, Arentz T, et al. Venice chart international consensus document on atrial fibrillation ablation. J Cardiovasc Electrophysiol 2007;18:560-80. https://doi.org/10.1111/j.1540-8167.2007.00816.x
  20. Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Transesophageal echocardiography in atrial fibrill-ation: standards for acquisition and interpretation and assessment of interobserver variability. J Am Soc Echocardiogr 1996;9:556-66.
  21. Amarenco P, Cohen A, Tzourio C, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 1994;331: 1474-9. https://doi.org/10.1056/NEJM199412013312202
  22. Otto CM. Textbook of Clinical Echocardiography. 4th ed. Philadelphia: W.B. Saunders Company;2009. p.125-56.
  23. Casaclang-Verzosa G, Gersh BJ, Tsang TS. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol 2008;51:1-11. https://doi.org/10.1016/j.jacc.2007.09.026
  24. Hwang GS, Kim YH, Kim MK, et al. Gene expression and ultrast-ructural remodeling in persistent atrial fibrillation. Korean Circ J 2004;34:693-705. https://doi.org/10.4070/kcj.2004.34.7.693
  25. Park JH, Oh YS, Kim JH, et al. Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on patients follow-ing ablation of atrial fibrillation. Korean Circ J 2009;39:185-9. https://doi.org/10.4070/kcj.2009.39.5.185
  26. Oakes RS, Badger TJ, Kholmovski EG, et al. Detection and quantific-ation of left arterial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circul-ation 2009;119:1758-67. https://doi.org/10.1161/CIRCULATIONAHA.108.811877
  27. Boisvert WA, Rose DM, Boullier RA, et al. Leukocyte transglutami-nase 2 expression limits atherosclerotic lesion size. Arterioscler Thromb Vasc Biol 2006;26:563-9.
  28. Mackey RH, Venkitachalam L, Sutton-Tyrrell K. Calcifications, arterial stiffness and atherosclerosis. Adv Cardiol 2007;44:234-44.
  29. Cheema A, Vasamreddy CR, Dalal D, et al. Long-term single procedure efficacy of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2006;15:145-55. https://doi.org/10.1007/s10840-006-9005-9
  30. Hof I, Arbab-Zadeh A, Scherr D, et al. Correlation of left atrial diame-ter by echocardiography and left atrial volume by computed tomography. J Cardiovasc Electrophysiol 2009;20:159-63. https://doi.org/10.1111/j.1540-8167.2008.01310.x

Cited by

  1. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes vol.30, pp.8, 2011, https://doi.org/10.1093/ajh/hpx013