Key result
Patients with paroxysmal atrial fibrillation had significantly lower left atrial mean flow velocities (13.1 vs. 16.7 cm/s) and higher stasis (43.2% vs. 27.8%) compared to controls during sinus rhythm.
Why the study?
The pathophysiology of thrombus formation in paroxysmal AF is complex and may involve LA flow changes, remodeling, or both.
Does paroxysmal atrial fibrillation alter left atrial 4D flow characteristics (velocity, stasis, kinetic energy) compared to healthy controls in the absence of apparent structural remodeling?
Case-Control (n=15)
No
Does paroxysmal atrial fibrillation alter left atrial 4D flow characteristics (velocity, stasis, kinetic energy) compared to healthy controls in the absence of apparent structural remodeling?
Paroxysmal AF is associated with impaired left atrial flow dynamics and increased stasis even during sinus rhythm and in the absence of structural remodeling, potentially explaining the increased thromboembolic risk in these patients.
Answers are grounded in this paper and cite their sources.
May explain thromboembolic risk in paroxysmal AF during sinus rhythm; hypothesis-generating and requires prospective validation.
The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.
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Demirkıran et al. (2021) conducted a case-control in Paroxysmal atrial fibrillation (n=15). Paroxysmal atrial fibrillation vs. Age and gender matched controls without cardiac disease was evaluated on Left atrial mean flow velocity over the entire cardiac cycle (cm/s) (p=0.01). Patients with paroxysmal atrial fibrillation had significantly lower left atrial mean flow velocities (13.1 vs. 16.7 cm/s) and higher stasis (43.2% vs. 27.8%) compared to controls during sinus rhythm.
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