Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group

Aims Despite advances in interventional treatment strategies, atrial fibrillation (AF) remains associated with significant morbidity and mortality. Fibrotic atrial myopathy (FAM) is a main factor for adverse outcomes of AF-ablation, but complex to diagnose using current methods. We aimed to derive a...

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Autores: Muller-Edenborn, B, Moreno-Weidmann, Z, Venier, S, Defaye, P, Park, CI, Guerra, J, Alonso-Martin, C, Bazan, V, Vinolas, X, Rodriguez-Font, E, Garcia, BC, Boveda, S, Combes, S, Albenque, JP, Guy-Moyat, B, Trenk, D, Eichenlaub, M, Chen, J, Lehrmann, H, Neumann, FJ, Arentz, T, Jadidi, A
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2022
País:España
Recursos:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositório:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p5175
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https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120434139&doi=10.1007%2fs00392-021-01973-1&partnerID=40&md5=6328a7cfa2e9e006028037c2e87a7f86
Access Level:Acceso aberto
Palavra-chave:Atrial fibrillation
Risk stratification
Pulmonary vein isolation
Fibrotic atrial myopathy
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spelling Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-groupMuller-Edenborn, BMoreno-Weidmann, ZVenier, SDefaye, PPark, CIGuerra, JAlonso-Martin, CBazan, VVinolas, XRodriguez-Font, EGarcia, BCBoveda, SCombes, SAlbenque, JPGuy-Moyat, BTrenk, DEichenlaub, MChen, JLehrmann, HNeumann, FJArentz, TJadidi, AAtrial fibrillationRisk stratificationPulmonary vein isolationFibrotic atrial myopathyAims Despite advances in interventional treatment strategies, atrial fibrillation (AF) remains associated with significant morbidity and mortality. Fibrotic atrial myopathy (FAM) is a main factor for adverse outcomes of AF-ablation, but complex to diagnose using current methods. We aimed to derive a scoring system based entirely on easily available clinical parameters to predict FAM and ablation-success in everyday care. Methods In this multicenter, prospective study, a new risk stratification model termed AF-SCORE was derived in 220 patients undergoing high-density left-atrial(LA) voltage-mapping to quantify FAM. AF-SCORE was validated for FAM in an external mapping-validation cohort (n = 220) and for success following pulmonary vein isolation (PVI)-only (without adjunctive left- or right atrial ablations) in an external outcome-validation cohort (n = 518). Results FAM was rare in patients < 60 years (5.4%), but increased with ageing and affected 40.4% (59/146) of patients >= 60 years. Sex and AF-phenotype had additional predictive value in older patients and remained associated with FAM in multivariate models (odds ratio [OR] 6.194, p < 0.0001 for > 60 years; OR 2.863, p < 0.0001 for female sex; OR 41.309, p < 0.0001 for AF-persistency). Additional clinical or diagnostic variables did not improve the model. AF-SCORE (+1 point for age >= 60 years and additional points for female sex [+1] and AF-persistency [+2]) showed good discrimination to detect FAM (c-statistic 0.792) and predicted arrhythmia-freedom following PVI (74.3%, 54.7% and 45.5% for AF-SCORE <= 2, 3 and 4, respectively, and hazard ratio [HR] 1.994 for AF-SCORE = 3 and HR 2.866 for AF-SCORE = 4, p < 0 .001). Conclusions Age, sex and AF-phenotype are the main determinants for the development of FAM. A low AF-SCORE <= 2 is found in paroxysmal AF-patients of any age and younger patients with persistent AF irrespective of sex, and associated with favorable outcomes of PVI-only. Freedom from arrhythmia remains unsatisfactory with AF-SCORE >= 3 as found in older patients, particularly females, with persistent AF, and future studies investigating adjunctive atrial ablations to PVI-only should focus on these groups of patients. [GRAPHICS] .SPRINGER HEIDELBERG2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5175https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120434139&doi=10.1007%2fs00392-021-01973-1&partnerID=40&md5=6328a7cfa2e9e006028037c2e87a7f86Clinical Research in CardiologyISSN: 18610684ISSNe: 18610692reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p51752026-06-14T12:41:47Z
dc.title.none.fl_str_mv Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
title Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
spellingShingle Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
Muller-Edenborn, B
Atrial fibrillation
Risk stratification
Pulmonary vein isolation
Fibrotic atrial myopathy
title_short Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
title_full Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
title_fullStr Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
title_full_unstemmed Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
title_sort Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau europeen de traitement d'arrhythmies cardiaques)-group
dc.creator.none.fl_str_mv Muller-Edenborn, B
Moreno-Weidmann, Z
Venier, S
Defaye, P
Park, CI
Guerra, J
Alonso-Martin, C
Bazan, V
Vinolas, X
Rodriguez-Font, E
Garcia, BC
Boveda, S
Combes, S
Albenque, JP
Guy-Moyat, B
Trenk, D
Eichenlaub, M
Chen, J
Lehrmann, H
Neumann, FJ
Arentz, T
Jadidi, A
author Muller-Edenborn, B
author_facet Muller-Edenborn, B
Moreno-Weidmann, Z
Venier, S
Defaye, P
Park, CI
Guerra, J
Alonso-Martin, C
Bazan, V
Vinolas, X
Rodriguez-Font, E
Garcia, BC
Boveda, S
Combes, S
Albenque, JP
Guy-Moyat, B
Trenk, D
Eichenlaub, M
Chen, J
Lehrmann, H
Neumann, FJ
Arentz, T
Jadidi, A
author_role author
author2 Moreno-Weidmann, Z
Venier, S
Defaye, P
Park, CI
Guerra, J
Alonso-Martin, C
Bazan, V
Vinolas, X
Rodriguez-Font, E
Garcia, BC
Boveda, S
Combes, S
Albenque, JP
Guy-Moyat, B
Trenk, D
Eichenlaub, M
Chen, J
Lehrmann, H
Neumann, FJ
Arentz, T
Jadidi, A
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Atrial fibrillation
Risk stratification
Pulmonary vein isolation
Fibrotic atrial myopathy
topic Atrial fibrillation
Risk stratification
Pulmonary vein isolation
Fibrotic atrial myopathy
description Aims Despite advances in interventional treatment strategies, atrial fibrillation (AF) remains associated with significant morbidity and mortality. Fibrotic atrial myopathy (FAM) is a main factor for adverse outcomes of AF-ablation, but complex to diagnose using current methods. We aimed to derive a scoring system based entirely on easily available clinical parameters to predict FAM and ablation-success in everyday care. Methods In this multicenter, prospective study, a new risk stratification model termed AF-SCORE was derived in 220 patients undergoing high-density left-atrial(LA) voltage-mapping to quantify FAM. AF-SCORE was validated for FAM in an external mapping-validation cohort (n = 220) and for success following pulmonary vein isolation (PVI)-only (without adjunctive left- or right atrial ablations) in an external outcome-validation cohort (n = 518). Results FAM was rare in patients < 60 years (5.4%), but increased with ageing and affected 40.4% (59/146) of patients >= 60 years. Sex and AF-phenotype had additional predictive value in older patients and remained associated with FAM in multivariate models (odds ratio [OR] 6.194, p < 0.0001 for > 60 years; OR 2.863, p < 0.0001 for female sex; OR 41.309, p < 0.0001 for AF-persistency). Additional clinical or diagnostic variables did not improve the model. AF-SCORE (+1 point for age >= 60 years and additional points for female sex [+1] and AF-persistency [+2]) showed good discrimination to detect FAM (c-statistic 0.792) and predicted arrhythmia-freedom following PVI (74.3%, 54.7% and 45.5% for AF-SCORE <= 2, 3 and 4, respectively, and hazard ratio [HR] 1.994 for AF-SCORE = 3 and HR 2.866 for AF-SCORE = 4, p < 0 .001). Conclusions Age, sex and AF-phenotype are the main determinants for the development of FAM. A low AF-SCORE <= 2 is found in paroxysmal AF-patients of any age and younger patients with persistent AF irrespective of sex, and associated with favorable outcomes of PVI-only. Freedom from arrhythmia remains unsatisfactory with AF-SCORE >= 3 as found in older patients, particularly females, with persistent AF, and future studies investigating adjunctive atrial ablations to PVI-only should focus on these groups of patients. [GRAPHICS] .
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5175
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120434139&doi=10.1007%2fs00392-021-01973-1&partnerID=40&md5=6328a7cfa2e9e006028037c2e87a7f86
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5175
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120434139&doi=10.1007%2fs00392-021-01973-1&partnerID=40&md5=6328a7cfa2e9e006028037c2e87a7f86
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGER HEIDELBERG
publisher.none.fl_str_mv SPRINGER HEIDELBERG
dc.source.none.fl_str_mv Clinical Research in Cardiology
ISSN: 18610684
ISSNe: 18610692
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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