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Left Atrial Function Determined by Cardiac Computed Tomography Predicts Device-Detected Atrial High-Rate Episodes in
Christoffer Tobias Witt1, Mads Brix Kronborg1, Anders Sommer1
1From the Department of Cardiology, Aarhus University Hospital, Aarhus.
Insights
In patients receiving cardiac resynchronization therapy (CRT), lower pre-implant left atrial emptying fraction (LAEF) independently predicts atrial high-rate episodes (AHREs). This finding highlights LAEF as a key indicator for AHRE risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Atrial high-rate episodes (AHREs) are a concern in patients with cardiac resynchronization therapy (CRT).
- Left atrial (LA) structure and function may influence arrhythmic events.
- Predictive markers for AHREs in CRT patients require further investigation.
Purpose of the Study:
- To investigate the association between left atrial (LA) volumes and function with atrial high-rate episodes (AHREs) in patients undergoing cardiac resynchronization therapy (CRT).
Main Methods:
- Ninety-two patients without prior atrial fibrillation were evaluated before and 6 months after CRT implantation.
- Cardiac computed tomography (CT) was used to derive left atrial volumes and LA emptying fraction (LAEF).
- Cox regression analysis assessed the relationship between baseline LA variables and AHRE occurrence.
Main Results:
- Twenty-four percent of patients developed AHREs during follow-up.
- Higher baseline LA emptying fraction (LAEF) was associated with a lower risk of AHRE (HR 0.94, P=0.003).
- Larger minimal left atrial volume (LAmin) was linked to a higher AHRE risk (HR 1.03, P=0.04), but LAEF remained the significant predictor when combined.
Conclusions:
- Pre-implantation left atrial emptying fraction (LAEF) measured by cardiac CT is an independent predictor of device-detected atrial high-rate episodes (AHREs) in patients with CRT.
- Lower LAEF is associated with an increased risk of AHREs, suggesting its utility in risk stratification.
Objective:
The objective of this study was to examine whether left atrial (LA) volumes and function were associated with atrial high-rate episodes (AHREs) in patients with cardiac resynchronization therapy (CRT).
Methods:
Ninety-two consecutive patients without prior atrial fibrillation underwent clinical evaluation, echocardiograms, and cardiac computed tomography (CT) before CRT implantation and after 6 months. Left atrial volumes and LA emptying fraction (LAEF) were derived by CT images reconstructed at 5% phase increments of the cardiac cycle. Cox regression was used to assess associations between AHRE and LA anatomical and functional variables.
Results:
Twenty-two patients (24%) developed AHRE during 1.9 years (SD, 1 year) At baseline, higher LAEF was associated with a lower risk of AHRE (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.91-0.98; P = 0.003), and large LA minimal (LAmin) volume was related to higher risk of AHRE (HR, 1.03; 95% CI, 1.00-1.06; P = 0.04). When combining LAEF and LAmin volume, only LAEF remained associated with occurrence of AHRE. Higher passive LAEF was associated with lower risk of AHRE (HR, 0.95; 95% CI, 0.91-0.98; P = 0.003).
Conclusions:
In patients with CRT, low preimplant LAEF measured by cardiac CT was independently associated with device-detected AHRE.
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