Korean Circ J.  2011 Apr;41(4):177-183. 10.4070/kcj.2011.41.4.177.

Association Between Plaque Thickness of the Thoracic Aorta and Recurrence of Atrial Fibrillation After Ablation

• Hwang HJ
• Lee MY
• Youn HJ
• Oh YS
• Rho TH
• Chung WS
• Park CS
• Choi YS
• Chung WB
• Lee JB
• Park HK
• Lim K
• Lee JH

• KMID: 2028941
• DOI: http://doi.org/10.4070/kcj.2011.41.4.177

Abstract

BACKGROUND AND OBJECTIVES
Several predictors of recurrence of atrial fibrillation (AF) after ablation have been identified, including age, type of AF, hypertension, left atrial diameter and impaired left ventricular ejection fraction. The aim of this study was to investigate whether the atherosclerotic plaque thickness of the thoracic aorta is associated with a recurrence of AF after circumferential pulmonary vein ablation (CPVA).
SUBJECTS AND METHODS
Among patients with drug-refractory paroxysmal or persistent AF, 105 consecutive (mean age 58+/-11 years, male : female=76 : 29) patients who underwent transesophageal echocardiography and CPVA were studied. The relationships between the recurrence of AF and variables, including clinical characteristics, plaque thickness of the thoracic aorta, laboratory findings and echocardiographic parameters were evaluated.
RESULTS
A univariate analysis showed that the presence of diabetes {hazard ratio (HR)=3.425; 95% confidence interval (CI), 1.422-8.249, p=0.006}, ischemic heart disease (HR=4.549; 95% CI, 1.679-12.322, p=0.003), duration of AF (HR=1.010; 95% CI, 1.001-1.018, p=0.025), type of AF (HR=2.412, 95% CI=1.042-5.584, p=0.040) and aortic plaque thickness with > or =4 mm (HR=9.514; 95% CI, 3.419-26.105, p<0.001) were significantly associated with the recurrence of AF after ablation. In Cox multivariate regression analysis, only the aortic plaque thickness (with > or =4 mm) was an independent predictor of recurrence of AF after ablation (HR=7.250, 95% CI=1.906-27.580, p=0.004).
CONCLUSION
Significantly increased aortic plaque thickness can be a predictable marker of recurrence of AF after CPVA.

Keyword

Atrial fibrillation; Catheter ablation; Atherosclerosis; Aorta, thoracic

MeSH Terms

Aorta, Thoracic
Atherosclerosis
Atrial Fibrillation
Catheter Ablation
Echocardiography, Transesophageal
Humans
Hypertension
Male
Myocardial Ischemia
Plaque, Atherosclerotic
Pulmonary Veins
Recurrence
Stroke Volume

Figure

• 

  Fig. 1 Short-axis transesophageal echocardiographic views of the thoracic aorta showing aortic plaque thickness. A: plaques with <1 mm thickness. B: 2.2 mm plaque thickness (1-3.9 mm). C: 7 mm plaque thickness (≥4 mm).

• 

  Fig. 2 Catheter ablation procedure for AF. A: a large sized Lasso catheter placed at the left and right ipsilateral circumferential pulmonary vein antrum. B: electroanatomic mapping and ablation (red dots) of the left and right antrum, roof line and mitral isthmus of the left atrium. Abl.: ablation catheter, HRA: high right atrium, CS: coronary sinus, His: His bundle, Lt.: left, Rt.: right, PV: pulmonary vein.

Reference

1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991. 22:983–988.

2. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998. 98:946–952.

3. Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003. 107:2920–2925.

4. Lee KS, Choi SJ, Park SH, Kim HL, Min H, Park HY. Prevalence of atrial fibrillation in middle-aged people in Korea: the Korean genome and epidemiology study. Korean Circ J. 2008. 38:601–605.

5. Sauer WH, McKernan ML, Lin D, Gerstenfeld EP, Callans DJ, Marchlinski FE. Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation. Heart Rhythm. 2006. 3:1024–1028.

6. Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med. 1995. 155:469–473.

7. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study. JAMA. 1994. 271:840–844.

8. Berruezo A, Tamborero D, Mont L, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007. 28:836–841.

9. Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Med. 2005. 118:489–495.

10. Goto S, Bhatt DL, Rother J, et al. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Am Heart J. 2008. 156:855–863.

11. Heeringa J, van der Kuip DA, Hofman A, et al. Subclinical atherosclerosis and risk of atrial fibrillation. Arch Intern Med. 2007. 167:382–387.

12. Blackshear JL, Pearce LA, Hart RG, et al. Aortic plaque in atrial fibrillation: prevalence, predictors, and thromboembolic implications. Stroke. 1999. 30:834–840.

13. Agmon Y, Khandheria BK, Meissner I, et al. Association of atrial fibrillation and aortic atherosclerosis: a population-based study. Mayo Clin Proc. 2001. 76:252–259.

14. De Potter T, Berruezo A, Mont L, et al. Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation. Europace. 2010. 12:24–29.

15. Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005. 111:1100–1105.

16. Chen MS, Marrouche NF, Khaykin Y, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol. 2004. 43:1004–1009.

17. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. Circulation. 2006. 114:e257–e354.

18. Calvo N, Mont L, Tamborero D, et al. Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes. Europace. 2010. 12:30–36.

19. Natale A, Raviele A, Arentz T, et al. Venice chart international consensus document on atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2007. 18:560–580.

20. Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Transesophageal echocardiography in atrial fibrillation: standards for acquisition and interpretation and assessment of interobserver variability. J Am Soc Echocardiogr. 1996. 9:556–566.

21. Amarenco P, Cohen A, Tzourio C, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med. 1994. 331:1474–1479.

22. Otto CM. Textbook of Clinical Echocardiography. 2009. 4th ed. Philadelphia: W.B. Saunders Company;125–156.

23. Casaclang-Verzosa G, Gersh BJ, Tsang TS. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol. 2008. 51:1–11.

24. Hwang GS, Kim YH, Kim MK, et al. Gene expression and ultrastructural remodeling in persistent atrial fibrillation. Korean Circ J. 2004. 34:693–705.

25. Park JH, Oh YS, Kim JH, et al. Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on patients following ablation of atrial fibrillation. Korean Circ J. 2009. 39:185–189.

26. Oakes RS, Badger TJ, Kholmovski EG, et al. Detection and quantification of left arterial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation. 2009. 119:1758–1767.

27. Boisvert WA, Rose DM, Boullier RA, et al. Leukocyte transglutaminase 2 expression limits atherosclerotic lesion size. Arterioscler Thromb Vasc Biol. 2006. 26:563–569.

28. Mackey RH, Venkitachalam L, Sutton-Tyrrell K. Calcifications, arterial stiffness and atherosclerosis. Adv Cardiol. 2007. 44:234–244.

29. Cheema A, Vasamreddy CR, Dalal D, et al. Long-term single procedure efficacy of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 2006. 15:145–155.

30. Hof I, Arbab-Zadeh A, Scherr D, et al. Correlation of left atrial diameter by echocardiography and left atrial volume by computed tomography. J Cardiovasc Electrophysiol. 2009. 20:159–163.