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Left Atrial Wall Stress Distribution and Its Relationship to Electrophysiologic Remodeling in Persistent Atrial Fibrillation.
MedLine Citation:
PMID:  22294615     Owner:  NLM     Status:  Publisher    
BACKGROUND: -Atrial stretch causes remodeling that predisposes to atrial fibrillation (AF). We tested the hypothesis that peaks in left atrial (LA) wall stress are associated with focal remodeling. METHODS AND RESULTS: -19 patients underwent LA mapping prior to catheter ablation for persistent AF. Finite Element Analysis was used to predict wall stress distribution based on LA geometry from CT. The relationship was assessed between wall stress and (1) electrogram voltage, and (2) complex fractionated atrial electrograms (CFAE) using CFAE mean (the mean interval between deflections). Wall stress varied widely within atria and between subjects (median 36 kPa, IQR 26 - 51 kP). Peaks in wall stress (≥ 90th percentile) were common at the pulmonary vein (PV) ostia (93%), the appendage ridge (100%), the high posterior wall (84%), the anterior wall and septal regions (42-84%). Electrogram voltage showed an inverse relationship across quartiles for wall stress (19% difference across quartiles, p = 0.016). There was no effect on CFAE mean across quartiles of wall stress. ROC analysis showed high wall stress was associated with low voltage (i.e. < 0.5 mV) and electrical scar (i.e. < 0.05 mV; both p < 0.0001), and with absence of CFAE (i.e. CFAE mean < 120ms; p < 0.0001). However, peaks in wall stress and CFAE were found at 88% of PV ostia. CONCLUSIONS: -Peaks in wall stress were associated with areas of low voltage suggestive of focal remodeling. Although peaks in wall stress were not associated with LA CFAE, the PV ostia may respond differently.
Ross J Hunter; Yankai Liu; Yiling Lu; Wen Wang; Richard J Schilling
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-31
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Barts & The London NHS Trust and QMUL, St Bartholomew's Hospital, London, United Kingdom;
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