Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau européen de traîtement d'arrhythmies cardiaques)-group
Müller-Edenborn, Björn (Julius-Hospital (Würzburg, Alemanya))
Moreno-Weidmann, Zoraida (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Venier, Sandrine (University Hospital Grenoble (França))
Defaye, Pascale (University Hospital Grenoble (França))
Park, Chan-il (Hôpital de La Tour (Suïssa))
Guerra, José (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Alonso-Martin, Concepción (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Bazán, Víctor (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Vinolas, Xavier (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Rodriguez-Font, Enrique (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Campos, Bieito (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Boveda, Serge (Clinique Pasteur (Toulouse, França))
Combes, Stéphane (Clinique Pasteur (Toulouse, França))
Albenque, Jean-Paul (Clinique Pasteur (Toulouse, França))
Guy-Moyat, Benoit (University Hospital Limoges)
Trenk, Dietmar (University of Freiburg)
Eichenlaub, Martin (University of Freiburg)
Chen, Juan (University Hospital Mainz (Alemanya))
Lehrmann, Heiko (University of Freiburg)
Neumann, Franz-Josef (University of Freiburg)
Arentz, Thomas (University of Freiburg)
Jadidi, Amir (University of Freiburg)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	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. 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). 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). 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. The online version contains supplementary material available at 10. 1007/s00392-021-01973-1.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Atrial fibrillation ; Fibrotic atrial myopathy ; Pulmonary vein isolation ; Risk stratification
Publicat a:	Clinical Research in Cardiology, Vol. 111 (december 2021) , p. 1018-1027, ISSN 1861-0692

DOI: 10.1007/s00392-021-01973-1
PMID: 34854991

10 p, 1.8 MB

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