Conduction velocity is reduced in the posterior wall of hypertrophic cardiomyopathy patients with normal bipolar voltage undergoing ablation for paroxysmal atrial fibrillation.
Biomedical engineering
Cardiac electrophysiology
Hypertrophic cardiomyopathy
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
23 Mar 2023
23 Mar 2023
Historique:
received:
16
12
2022
accepted:
15
03
2023
entrez:
23
3
2023
pubmed:
24
3
2023
medline:
24
3
2023
Statut:
aheadofprint
Résumé
We investigated characteristics of left atrial conduction in patients with HCM, paroxysmal AF and normal bipolar voltage. Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement. The incidence of atrial fibrillation (AF) is increased fourfold in patients with HCM and confers a fourfold increased risk of death. Catheter ablation is less effective in HCM, with twofold increased risk of AF recurrence. The mechanisms of AF perpetuation in HCM are poorly understood. We analyzed 20 patients with HCM and 20 controls presenting for radiofrequency ablation of paroxysmal AF normal left atrial voltage(> 0.5 mV). Intracardiac electrograms were extracted from the CARTO mapping system and analyzed using Matlab/Python code interfacing with Core OpenEP software. Conduction velocity maps were calculated using local activation time gradients. There were no differences in baseline demographics, atrial size, or valvular disease between HCM and control patients. Patients with HCM had significantly reduced atrial conduction velocity compared to controls (0.44 ± 0.17 vs 0.56 ± 0.10 m/s, p = 0.01), despite no significant differences in bipolar voltage amplitude (1.23 ± 0.38 vs 1.20 ± 0.41 mV, p = 0.76). There was a statistically significant reduction in conduction velocity in the posterior left atrium in HCM patients relative to controls (0.43 ± 0.18 vs 0.58 ± 0.10 m/s, p = 0.003), but not in the anterior left atrium (0.46 ± 0.17 vs 0.55 ± 0.10 m/s, p = 0.05). There was a significant association between conduction velocity and interventricular septal thickness (slope = -0.013, R Atrial conduction velocity is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia persistence after catheter ablation.
Sections du résumé
OBJECTIVES
OBJECTIVE
We investigated characteristics of left atrial conduction in patients with HCM, paroxysmal AF and normal bipolar voltage.
BACKGROUND
BACKGROUND
Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement. The incidence of atrial fibrillation (AF) is increased fourfold in patients with HCM and confers a fourfold increased risk of death. Catheter ablation is less effective in HCM, with twofold increased risk of AF recurrence. The mechanisms of AF perpetuation in HCM are poorly understood.
METHODS
METHODS
We analyzed 20 patients with HCM and 20 controls presenting for radiofrequency ablation of paroxysmal AF normal left atrial voltage(> 0.5 mV). Intracardiac electrograms were extracted from the CARTO mapping system and analyzed using Matlab/Python code interfacing with Core OpenEP software. Conduction velocity maps were calculated using local activation time gradients.
RESULTS
RESULTS
There were no differences in baseline demographics, atrial size, or valvular disease between HCM and control patients. Patients with HCM had significantly reduced atrial conduction velocity compared to controls (0.44 ± 0.17 vs 0.56 ± 0.10 m/s, p = 0.01), despite no significant differences in bipolar voltage amplitude (1.23 ± 0.38 vs 1.20 ± 0.41 mV, p = 0.76). There was a statistically significant reduction in conduction velocity in the posterior left atrium in HCM patients relative to controls (0.43 ± 0.18 vs 0.58 ± 0.10 m/s, p = 0.003), but not in the anterior left atrium (0.46 ± 0.17 vs 0.55 ± 0.10 m/s, p = 0.05). There was a significant association between conduction velocity and interventricular septal thickness (slope = -0.013, R
CONCLUSIONS
CONCLUSIONS
Atrial conduction velocity is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia persistence after catheter ablation.
Identifiants
pubmed: 36952090
doi: 10.1007/s10840-023-01533-9
pii: 10.1007/s10840-023-01533-9
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
Références
Maron BJ, Olivotto I, Spirito P, et al. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation. 2000;102(8):858–64.
doi: 10.1161/01.CIR.102.8.858
pubmed: 10952953
Olivotto I, Cecchi F, Casey SA, et al. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation. 2001;104(21):2517–24.
doi: 10.1161/hc4601.097997
pubmed: 11714644
Siontis KC, Geske JB, Ong K, et al. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. J Am Heart Assoc. 2014;3(3):e001002.
doi: 10.1161/JAHA.114.001002
pubmed: 24965028
pmcid: 4309084
Patten M, Pecha S, Aydin A. Atrial fibrillation in hypertrophic cardiomyopathy: diagnosis and considerations for management. J Atr Fibrillation. 2018;10(5):1556.
doi: 10.4022/jafib.1556
pubmed: 29988228
pmcid: 6006972
Maron BJ, Casey SA, Hauser RG, Aeppli DM. Clinical course of hypertrophic cardiomyopathy with survival to advanced age. J Am Coll Cardiol. 2003;42(5):882–8.
doi: 10.1016/S0735-1097(03)00855-6
pubmed: 12957437
Maron BJ, Rowin EJ, Casey SA, et al. Hypertrophic cardiomyopathy in adulthood associated with low cardiovascular mortality with contemporary management strategies. J Am Coll Cardiol. 2015;65(18):1915–28.
doi: 10.1016/j.jacc.2015.02.061
pubmed: 25953744
Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.
doi: 10.1056/NEJM199809033391003
pubmed: 9725923
Ho CY, Lopez B, Coelho-Filho OR, et al. Myocardial fibrosis as an early manifestation of hypertrophic cardiomyopathy. N Engl J Med. 2010;363(6):552–63.
doi: 10.1056/NEJMoa1002659
pubmed: 20818890
pmcid: 3049917
Keane S, Fabre A, Keane D. Characterization of atrial histology in a patient with hypertrophic cardiomyopathy: Possible evidence of a primary atrial myopathy. HeartRhythm Case Rep. 2021;7(6):413–7.
doi: 10.1016/j.hrcr.2021.03.017
pubmed: 34194992
pmcid: 8226312
Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol. 2008;51(8):802–9.
doi: 10.1016/j.jacc.2007.09.064
pubmed: 18294563
Miller CAS, Maron MS, Estes NAM III, et al. Safety, side effects and relative efficacy of medications for rhythm control of atrial fibrillation in hypertrophic cardiomyopathy. Am J Cardiol. 2019;123(11):1859–62.
doi: 10.1016/j.amjcard.2019.02.051
pubmed: 30922542
Malasana G, Day JD, Bunch TJ. Atrial fibrillation in hypertrophic obstructive cardiomyopathy - antiarrhythmics, ablation and more! J Atr Fibrillation. 2009;2(3):210.
pubmed: 28496641
pmcid: 5398829
Kilicaslan F, Verma A, Saad E, et al. Efficacy of catheter ablation of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy. Heart Rhythm. 2006;3(3):275–80.
doi: 10.1016/j.hrthm.2005.11.013
pubmed: 16500298
Santangeli P, Di Biase L, Themistoclakis S, et al. Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy: long-term outcomes and mechanisms of arrhythmia recurrence. Circ Arrhythm Electrophysiol. 2013;6(6):1089–94.
doi: 10.1161/CIRCEP.113.000339
pubmed: 24114776
Gaita F, Di Donna P, Olivotto I, et al. Usefulness and safety of transcatheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy. Am J Cardiol. 2007;99(11):1575–81.
doi: 10.1016/j.amjcard.2006.12.087
pubmed: 17531584
Di Donna P, Olivotto I, Delcre SD, et al. Efficacy of catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: impact of age, atrial remodelling, and disease progression. Europace. 2010;12(3):347–55.
doi: 10.1093/europace/euq013
pubmed: 20173211
Providencia R, Elliott P, Patel K, et al. Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis. Heart. 2016;102(19):1533–43.
doi: 10.1136/heartjnl-2016-309406
pubmed: 27234160
Dinshaw L, Munkler P, Schaffer B, et al. Ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: treatment strategy, characteristics of consecutive atrial tachycardia and long-term outcome. J Am Heart Assoc. 2021;10(3):e017451.
doi: 10.1161/JAHA.120.017451
pubmed: 33455428
pmcid: 7955439
Williams SE, Linton N, O’Neill L, et al. The effect of activation rate on left atrial bipolar voltage in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2017;28(9):1028–36.
doi: 10.1111/jce.13282
pubmed: 28639747
pmcid: 5639376
Shah CD, Everett THIV. Revisiting bipolar voltage mapping; Does the amplitude correlate to conduction velocity? Heart Rhythm. 2023;20(3):438–9.
Ramirez FD, Meo M, Dallet C, et al. High-resolution mapping of reentrant atrial tachycardias: Relevance of low bipolar voltage. Heart Rhythm. 2023;20(3):430–7.
Fukumoto K, Habibi M, Ipek EG, et al. Association of Left Atrial Local Conduction Velocity With Late Gadolinium Enhancement on Cardiac Magnetic Resonance in Patients With Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2016;9(3):e002897.
doi: 10.1161/CIRCEP.115.002897
pubmed: 26917814
pmcid: 4772170
Ustunkaya T, Desjardins B, Liu B, et al. Association of regional myocardial conduction velocity with the distribution of hypoattenuation on contrast-enhanced perfusion computed tomography in patients with postinfarct ventricular tachycardia. Heart Rhythm. 2019;16(4):588–94.
doi: 10.1016/j.hrthm.2018.10.029
pubmed: 30935494
Ustunkaya T, Desjardins B, Wedan R, et al. Epicardial conduction speed, electrogram abnormality, and computed tomography attenuation associations in arrhythmogenic right ventricular cardiomyopathy. JACC Clin Electrophysiol. 2019;5(10):1158–67.
doi: 10.1016/j.jacep.2019.06.017
pubmed: 31648740
pmcid: 6818747
Williams SE, Roney CH, Connolly A, et al. OpenEP: a cross-platform electroanatomic mapping data format and analysis platform for electrophysiology research. Front Physiol. 2021;12:646023.
doi: 10.3389/fphys.2021.646023
pubmed: 33716795
pmcid: 7952326
King JH, Huang CL, Fraser JA. Determinants of myocardial conduction velocity: implications for arrhythmogenesis. Front Physiol. 2013;4:154.
doi: 10.3389/fphys.2013.00154
pubmed: 23825462
pmcid: 3695374
O’Hanlon R, Grasso A, Roughton M, et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010;56(11):867–74.
doi: 10.1016/j.jacc.2010.05.010
pubmed: 20688032
Efremidis M, Bazoukis G, Vlachos K, et al. Atrial substrate characterization in patients with atrial fibrillation and hypertrophic cardiomyopathy: Evidence for an extensive fibrotic disease. J Electrocardiol. 2021;69:87–92.
doi: 10.1016/j.jelectrocard.2021.06.001
pubmed: 34619440
Medi C, Kalman JM, Spence SJ, et al. Atrial electrical and structural changes associated with longstanding hypertension in humans: implications for the substrate for atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22(12):1317–24.
doi: 10.1111/j.1540-8167.2011.02125.x
pubmed: 21736657
Lim WW, Neo M, Thanigaimani S, et al. Electrophysiological and structural remodeling of the atria in a mouse model of Troponin-I mutation linked hypertrophic cardiomyopathy: Implications for atrial fibrillation. Int J Mol Sci. 2021;22(13).
Wang L, Seidman JG, Seidman CE. Narrative review: harnessing molecular genetics for the diagnosis and management of hypertrophic cardiomyopathy. Ann Intern Med. 2010;152(8):513–20, W181.
Barajas-Martinez H, Hu D, Goodrow RJ Jr, Joyce F, Antzelevitch C. Electrophysiologic characteristics and pharmacologic response of human cardiomyocytes isolated from a patient with hypertrophic cardiomyopathy. Pacing Clin Electrophysiol. 2013;36(12):1512–5.
doi: 10.1111/pace.12227
pubmed: 24117780
Coppini R, Santini L, Olivotto I, Ackerman MJ, Cerbai E. Abnormalities in sodium current and calcium homoeostasis as drivers of arrhythmogenesis in hypertrophic cardiomyopathy. Cardiovasc Res. 2020;116(9):1585–99.
doi: 10.1093/cvr/cvaa124
pubmed: 32365196
Casini S, Verkerk AO, van Borren MM, et al. Intracellular calcium modulation of voltage-gated sodium channels in ventricular myocytes. Cardiovasc Res. 2009;81(1):72–81.
doi: 10.1093/cvr/cvn274
pubmed: 18829699
Benito EM, Cabanelas N, Nunez-Garcia M, et al. Preferential regional distribution of atrial fibrosis in posterior wall around left inferior pulmonary vein as identified by late gadolinium enhancement cardiac magnetic resonance in patients with atrial fibrillation. Europace. 2018;20(12):1959–65.
doi: 10.1093/europace/euy095
pubmed: 29860416
Daccarett M, Badger TJ, Akoum N, et al. Association of left atrial fibrosis detected by delayed-enhancement magnetic resonance imaging and the risk of stroke in patients with atrial fibrillation. J Am Coll Cardiol. 2011;57(7):831–8.
doi: 10.1016/j.jacc.2010.09.049
pubmed: 21310320
pmcid: 3124509
Po SS, Nakagawa H, Jackman WM. Localization of left atrial ganglionated plexi in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2009;20(10):1186–9.
doi: 10.1111/j.1540-8167.2009.01515.x
pubmed: 19563367
Ho SY, Anderson RH, Sanchez-Quintana D. Atrial structure and fibres: morphologic bases of atrial conduction. Cardiovasc Res. 2002;54(2):325–36.
doi: 10.1016/S0008-6363(02)00226-2
pubmed: 12062338
Pashakhanloo F, Herzka DA, Ashikaga H, et al. Myofiber architecture of the human atria as revealed by submillimeter diffusion tensor imaging. Circ Arrhythm Electrophysiol. 2016;9(4):e004133.
doi: 10.1161/CIRCEP.116.004133
pubmed: 27071829
pmcid: 7035884
Vlachos K, Efremidis M, Letsas KP, et al. Low-voltage areas detected by high-density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2017;28(12):1393–402.
doi: 10.1111/jce.13321
pubmed: 28884923
Spirito P, Lakatos E, Maron BJ. Degree of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy and chronic atrial fibrillation. Am J Cardiol. 1992;69(14):1217–22.
doi: 10.1016/0002-9149(92)90939-V
pubmed: 1533490
Apostolakis S, Sullivan RM, Olshansky B, Lip GY. Left ventricular geometry and outcomes in patients with atrial fibrillation: the AFFIRM Trial. Int J Cardiol. 2014;170(3):303–8.
doi: 10.1016/j.ijcard.2013.11.002
pubmed: 24315343
Shah AM, Claggett B, Sweitzer NK, et al. Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial. Circ Heart Fail. 2014;7(5):740–51.
doi: 10.1161/CIRCHEARTFAILURE.114.001583
pubmed: 25122186
pmcid: 4916914
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561–6.
doi: 10.1056/NEJM199005313222203
pubmed: 2139921
Han B, Trew ML, Zgierski-Johnston CM. Cardiac conduction velocity, remodeling and arrhythmogenesis. Cells. 2021;10(11).