Localized Pulmonary Vein Scar Promotes Atrial Fibrillation in High Left Atrial Pressure
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Localized Pulmonary Vein Scar Promotes Atrial Fibrillation in High Left Atrial Pressure. / Gottlieb, Lisa A; Vaillant, Fanny; Abell, Emma; Belterman, Charly; Loyer, Virginie; El Hamrani, Dounia; Naulin, Jérôme; Constantin, Marion; Quesson, Bruno; Boukens, Bastiaan J; Coronel, Ruben; Dekker, Lukas R C.
I: Frontiers in Physiology, Bind 12, 709844, 2021.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Localized Pulmonary Vein Scar Promotes Atrial Fibrillation in High Left Atrial Pressure
AU - Gottlieb, Lisa A
AU - Vaillant, Fanny
AU - Abell, Emma
AU - Belterman, Charly
AU - Loyer, Virginie
AU - El Hamrani, Dounia
AU - Naulin, Jérôme
AU - Constantin, Marion
AU - Quesson, Bruno
AU - Boukens, Bastiaan J
AU - Coronel, Ruben
AU - Dekker, Lukas R C
N1 - Copyright © 2021 Gottlieb, Vaillant, Abell, Belterman, Loyer, El Hamrani, Naulin, Constantin, Quesson, Boukens, Coronel and Dekker.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Pulmonary vein (PV) ablation is unsuccessful in atrial fibrillation (AF) patients with high left atrial (LA) pressure. Increased atrial stretch by increased pressure is proarrhythmic for AF, and myocardial scar alters wall deformation. We hypothesized that localized PV scar is proarrhythmic for AF in high LA pressure.METHODS: Radiofrequency energy was delivered locally in the right PV of healthy sheep. The sheep recovered for 4 months. Explanted hearts (n = 9 PV scar, n = 9 controls) were perfused with 1:4 blood:Tyrode's solution in a four-chamber working heart setup. Programmed PV stimulation was performed during low (∼12 mmHg) and high (∼25 mmHg) LA pressure. An AF inducibility index was calculated based on the number of induction attempts and the number of attempts causing AF (run of ≥ 20 premature atrial complexes).RESULTS: In high LA pressure, the presence of PV scar increased the AF inducibility index compared with control hearts (0.83 ± 0.20 vs. 0.38 ± 0.40 arb. unit, respectively, p = 0.014). The diastolic stimulation threshold in high LA pressure was higher (108 ± 23 vs. 77 ± 16 mA, respectively, p = 0.006), and its heterogeneity was increased in hearts with PV scar compared with controls. In high LA pressure, the refractory period was shorter in PV scar than in control hearts (178 ± 39 vs. 235 ± 48 ms, p = 0.011).CONCLUSION: Localized PV scar only in combination with increased LA pressure facilitated the inducibility of AF. This was associated with changes in tissue excitability remote from the PV scar. Localized PV ablation is potentially proarrhythmic in patients with increased LA pressure.
AB - BACKGROUND: Pulmonary vein (PV) ablation is unsuccessful in atrial fibrillation (AF) patients with high left atrial (LA) pressure. Increased atrial stretch by increased pressure is proarrhythmic for AF, and myocardial scar alters wall deformation. We hypothesized that localized PV scar is proarrhythmic for AF in high LA pressure.METHODS: Radiofrequency energy was delivered locally in the right PV of healthy sheep. The sheep recovered for 4 months. Explanted hearts (n = 9 PV scar, n = 9 controls) were perfused with 1:4 blood:Tyrode's solution in a four-chamber working heart setup. Programmed PV stimulation was performed during low (∼12 mmHg) and high (∼25 mmHg) LA pressure. An AF inducibility index was calculated based on the number of induction attempts and the number of attempts causing AF (run of ≥ 20 premature atrial complexes).RESULTS: In high LA pressure, the presence of PV scar increased the AF inducibility index compared with control hearts (0.83 ± 0.20 vs. 0.38 ± 0.40 arb. unit, respectively, p = 0.014). The diastolic stimulation threshold in high LA pressure was higher (108 ± 23 vs. 77 ± 16 mA, respectively, p = 0.006), and its heterogeneity was increased in hearts with PV scar compared with controls. In high LA pressure, the refractory period was shorter in PV scar than in control hearts (178 ± 39 vs. 235 ± 48 ms, p = 0.011).CONCLUSION: Localized PV scar only in combination with increased LA pressure facilitated the inducibility of AF. This was associated with changes in tissue excitability remote from the PV scar. Localized PV ablation is potentially proarrhythmic in patients with increased LA pressure.
U2 - 10.3389/fphys.2021.709844
DO - 10.3389/fphys.2021.709844
M3 - Journal article
C2 - 34512384
VL - 12
JO - Frontiers in Physiology
JF - Frontiers in Physiology
SN - 1664-042X
M1 - 709844
ER -
ID: 396850456