Scientific Reports | 2021
Characteristics of left atrial remodeling in patients with atrial fibrillation and hypertrophic cardiomyopathy in comparison to patients without hypertrophy
Abstract
Atrial fibrillation (AF) leads to remodeling characterized by changes in both size and shape of the left atrium (LA). Here we aimed to study the effect of hypertrophic cardiomyopathy (HCM) on the pattern of LA remodeling in AF-patients. HCM-patients (n\u2009=\u200923) undergoing AF ablation (2009–2012) were matched and compared with 125 Non-HCM patients from our prospective registry. Pre-procedural CT data were analyzed (EnSite Verismo, SJM, MN) to determine the maximal sagittal (anterior–posterior, AP), coronal (superior-inferior, SI and transversal, TV) dimensions and the sphericity index (LAS). Volume (LAV) was rendered after appendage (LAA) and pulmonary vein (PV) exclusion. A cutting plane, between PV ostia/LAA and parallel to the posterior wall, divided LAV into anterior- (LAA) and posterior-LA (LAP) parts. The ratio LA-A/LAV was defined as asymmetry index (ASI). HCM patients had a wider inter-ventricular septum and a smaller LV than Non-HCM patients. LA volume (LAV 166\u2009±\u200972 vs. 130\u2009±\u200936 ml, p\u2009=\u20090.03) and LA diameters were significantly larger in HCM patients. Anterior volume (LA-A: 112\u2009±\u200948 vs. 83\u2009±\u200926 ml, p\u2009<\u20090.001) differed significantly between groups, whereas the posterior volume LA-P (55\u2009±\u200928 vs. 47\u2009±\u200913 ml, p\u2009=\u20090.23) and LAS (75% vs. 78%, p\u2009=\u20090.089) was similar in both groups. As a result, ASI was significantly higher (67\u2009±\u20096 vs. 63\u2009±\u20096%, p\u2009=\u20090.01) in HCM than in Non-HCM patients. In conclusion, LA remodeling in patients with AF and HCM is characterized by asymmetric dilatation, driven by an anterior rather than a posterior dilatation. This can be characterized by three-dimensional imaging and could be used as surrogate of advanced atrial remodeling.