What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Fibrillation (n=298). Intervention: History of atrial fibrillation vs. No history of atrial fibrillation. Primary outcome: Left atrial posterior wall thickness.

February 13, 2008Open Access

Left Atrial Posterior Wall Thickness in Patients with and without Atrial Fibrillation: Data from 298 Consecutive Autopsies

PPPyotr G. PlatonovElectrophysiology VIVitaly IvanovFirst Pavlov State Medical University of St. Petersburg SHSiew Yen HoAdult Congenital Heart Disease

Key Result

Patients with a history of atrial fibrillation had a thinner left atrial posterior wall at the center and inferior pulmonary vein levels compared to those without atrial fibrillation.

Study Design

Type

Observational (n=298)

Multicenter

Structured PICO

Is left atrial posterior wall thickness different in patients with and without a history of atrial fibrillation?

Population

298 consecutive autopsies (142 male, age 61 +/- 17 years), including 59 subjects (20%) with documented atrial fibrillation.

Comparator

Subjects without a history of atrial fibrillation

Outcome

Left atrial posterior wall thickness measured at three levels (between superior pulmonary veins, center of posterior LA wall, and between inferior pulmonary veins)surrogate

Patients with a history of atrial fibrillation have a thinner left atrial posterior wall, which has clinical implications for understanding complication risks and improving the safety of AF ablation procedures.

Limitations

Patients with history of AF were significantly older than those without AF
No analysis of underlying disease was possible to evaluate its impact on atrial pathology
The three points selected for measurement may not be the most clinically relevant for assessment of possible wall damage

Abstract

INTRODUCTION: Radiofrequency ablation of atrial fibrillation (AF) is associated with energy delivery on the posterior left atrial (LA) wall with small but significant risk of life-threatening complications. Anatomy of LA walls has been described, but wall thickness in patients with AF has not been studied systematically. The aim of the present study was to describe LA posterior wall thickness in patients with and without history of AF. METHODS AND RESULTS: Heart mass and LA wall thickness was measured during 298 consecutive autopsies (142 male, age 61 +/- 17 years). LA posterior wall was measured at three levels: between the superior pulmonary veins (SPV), in the center of the posterior LA wall (CPV), and between the inferior pulmonary veins (IPV). Information about AF history was obtained from medical records. Fifty-nine subjects (20%) had documented AF. They were older than subjects without AF (74 +/- 10 years vs 58 +/- 17 years, P < 0.0001) and had greater heart mass (522 +/- 114 g vs 389 +/- 99 g, P < 0.0001). LA posterior wall thickness increased from the most superior to the most inferior measured level (2.3 +/- 0.9 mm vs 2.5 +/- 1.0 mm vs 2.9 +/- 1.3 mm for SPV, CPV, and IPV, respectively; P < 0.001). Subjects with AF history had thinner LA posterior wall at CPV and IPV compared with those without AF. CONCLUSIONS: LA posterior wall thickness is described on a large series of consecutive autopsies. LA posterior wall is found to be generally thinner in patients with history of AF. Study results have clinical implications for understanding complication risk and improvement of safety of AF ablation procedures.

AIに質問

Bookmark

View Full Paper