Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation

Jose Antonio L. Bautista; Chin Yu Lin; Chi Ting Lu; Li Wei Lo; Yenn Jiang Lin; Shih Lin Chang; Yu Feng Hu; Fa Po Chung; Ta Chuan Tuan; Tze Fan Chao; Jo Nan Liao; Ting Yung Chang; Ling Kuo; Chih Min Liu; Shin Huei Liu; Cheng I. Wu; Ming Jen Kuo; Guan Yi Li; Yu Shan Huang; Shang Ju Wu; Yoon Kee Siow; Ngoc Nguyen Dinh Son; Dat Cao Tran; Shih Ann Chen

doi:10.3389/fcvm.2023.1265890

Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation

Jose Antonio L. Bautista, Chin Yu Lin^*, Chi Ting Lu, Li Wei Lo, Yenn Jiang Lin, Shih Lin Chang, Yu Feng Hu, Fa Po Chung, Ta Chuan Tuan, Tze Fan Chao, Jo Nan Liao, Ting Yung Chang, Ling Kuo, Chih Min Liu, Shin Huei Liu, Cheng I. Wu, Ming Jen Kuo, Guan Yi Li, Yu Shan Huang, Shang Ju WuYoon Kee Siow, Ngoc Nguyen Dinh Son, Dat Cao Tran, Shih Ann Chen

^*Corresponding author for this work

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Atrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients. Methods: Patients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA. Results: Fifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHA₂DS₂-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, P = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, P = 0.007) and diabetes mellitus (3.1% vs. 22.2%, P = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, P < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation. Conclusion: Most patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.

Original language	English
Article number	1265890
Journal	Frontiers in Cardiovascular Medicine
Volume	10
DOIs	https://doi.org/10.3389/fcvm.2023.1265890
State	Published - 2023

Keywords

ablation
atrial fibrillation
catheter ablation
echocardiography atrial fibrillation
mitral regurgitation
scar
substrate

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Bautista, J. A. L., Lin, C. Y., Lu, C. T., Lo, L. W., Lin, Y. J., Chang, S. L., Hu, Y. F., Chung, F. P., Tuan, T. C., Chao, T. F., Liao, J. N., Chang, T. Y., Kuo, L., Liu, C. M., Liu, S. H., Wu, C. I., Kuo, M. J., Li, G. Y., Huang, Y. S., ... Chen, S. A. (2023). Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation. Frontiers in Cardiovascular Medicine, 10, Article 1265890. https://doi.org/10.3389/fcvm.2023.1265890

@article{7433c2bd99644fe5877aa69621051504,

title = "Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation",

abstract = "Background: Atrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients. Methods: Patients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA. Results: Fifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHA2DS2-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, P = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, P = 0.007) and diabetes mellitus (3.1% vs. 22.2%, P = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, P < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation. Conclusion: Most patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.",

keywords = "ablation, atrial fibrillation, catheter ablation, echocardiography atrial fibrillation, mitral regurgitation, scar, substrate",

author = "Bautista, {Jose Antonio L.} and Lin, {Chin Yu} and Lu, {Chi Ting} and Lo, {Li Wei} and Lin, {Yenn Jiang} and Chang, {Shih Lin} and Hu, {Yu Feng} and Chung, {Fa Po} and Tuan, {Ta Chuan} and Chao, {Tze Fan} and Liao, {Jo Nan} and Chang, {Ting Yung} and Ling Kuo and Liu, {Chih Min} and Liu, {Shin Huei} and Wu, {Cheng I.} and Kuo, {Ming Jen} and Li, {Guan Yi} and Huang, {Yu Shan} and Wu, {Shang Ju} and Siow, {Yoon Kee} and Son, {Ngoc Nguyen Dinh} and Tran, {Dat Cao} and Chen, {Shih Ann}",

note = "Publisher Copyright: 2023 Bautista, Lin, Lu, Lo, Lin, Chang, Hu, Chung, Tuan, Chao, Liao, Chang, Kuo, Liu, Liu, Wu, Kuo, Li, Huang, Wu, Siow, Son, Tran and Chen.",

year = "2023",

doi = "10.3389/fcvm.2023.1265890",

language = "English",

volume = "10",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media SA",

}

Bautista, JAL, Lin, CY, Lu, CT, Lo, LW, Lin, YJ, Chang, SL , Hu, YF, Chung, FP, Tuan, TC, Chao, TF, Liao, JN, Chang, TY, Kuo, L, Liu, CM, Liu, SH, Wu, CI, Kuo, MJ, Li, GY, Huang, YS, Wu, SJ, Siow, YK, Son, NND, Tran, DC & Chen, SA 2023, 'Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation', Frontiers in Cardiovascular Medicine, vol. 10, 1265890. https://doi.org/10.3389/fcvm.2023.1265890

TY - JOUR

T1 - Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation

AU - Bautista, Jose Antonio L.

AU - Lin, Chin Yu

AU - Lu, Chi Ting

AU - Lo, Li Wei

AU - Lin, Yenn Jiang

AU - Chang, Shih Lin

AU - Hu, Yu Feng

AU - Chung, Fa Po

AU - Tuan, Ta Chuan

AU - Chao, Tze Fan

AU - Liao, Jo Nan

AU - Chang, Ting Yung

AU - Kuo, Ling

AU - Liu, Chih Min

AU - Liu, Shin Huei

AU - Wu, Cheng I.

AU - Kuo, Ming Jen

AU - Li, Guan Yi

AU - Huang, Yu Shan

AU - Wu, Shang Ju

AU - Siow, Yoon Kee

AU - Son, Ngoc Nguyen Dinh

AU - Tran, Dat Cao

AU - Chen, Shih Ann

N1 - Publisher Copyright: 2023 Bautista, Lin, Lu, Lo, Lin, Chang, Hu, Chung, Tuan, Chao, Liao, Chang, Kuo, Liu, Liu, Wu, Kuo, Li, Huang, Wu, Siow, Son, Tran and Chen.

PY - 2023

Y1 - 2023

N2 - Background: Atrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients. Methods: Patients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA. Results: Fifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHA2DS2-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, P = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, P = 0.007) and diabetes mellitus (3.1% vs. 22.2%, P = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, P < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation. Conclusion: Most patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.

AB - Background: Atrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients. Methods: Patients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA. Results: Fifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHA2DS2-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, P = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, P = 0.007) and diabetes mellitus (3.1% vs. 22.2%, P = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, P < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation. Conclusion: Most patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.

KW - ablation

KW - atrial fibrillation

KW - catheter ablation

KW - echocardiography atrial fibrillation

KW - mitral regurgitation

KW - scar

KW - substrate

UR - http://www.scopus.com/inward/record.url?scp=85176245671&partnerID=8YFLogxK

U2 - 10.3389/fcvm.2023.1265890

DO - 10.3389/fcvm.2023.1265890

M3 - Article

AN - SCOPUS:85176245671

SN - 2297-055X

VL - 10

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 1265890

ER -

Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation

Abstract

Keywords

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