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Atrial fibrillation is associated with large beat-to-beat variability in mitral and tricuspid annulus dimensions

Jwan A Naser1, Hilal Olgun Kucuk1, Andrea O Ciobanu2,3

  • 1Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.

European Heart Journal. Cardiovascular Imaging
|March 16, 2021
PubMed

Insights

Atrial fibrillation (Afib) causes greater beat-to-beat variability in mitral and tricuspid annulus size and timing than sinus rhythm. This finding is crucial for selecting percutaneous devices in patients with Afib and valve disease.

Area of Science:

  • Cardiovascular Imaging
  • Cardiac Electrophysiology
  • Valvular Heart Disease

Background:

  • Beat-to-beat variability in cardiac cycle length is a known characteristic of atrial fibrillation (Afib).
  • The impact of Afib on the variability of mitral and tricuspid annulus size remains largely unexplored.
  • Accurate assessment of annulus size is critical for percutaneous device selection, especially in patients with coexisting mitral and tricuspid valve disease.

Purpose of the Study:

  • To investigate whether atrial fibrillation (Afib) influences the beat-to-beat variability of mitral annulus (MA) and tricuspid annulus (TA) size.
  • To compare the variability in annulus size and the timing of maximal annulus size between patients in sinus rhythm (SR) and Afib.
  • To provide data that can aid in the selection of percutaneous devices for valve interventions in patients with Afib.

Main Methods:

  • Utilized 3D echocardiography to acquire images from 170 patients (100 for MA, 70 for TA), including subgroups in SR and Afib.
  • Employed commercially available software to analyze annular dynamics and quantify the beat-to-beat variability in maximal annulus area over 4-6 cardiac cycles.
  • Assessed the timing of maximal annulus size relative to the R-R interval in each analyzed cardiac cycle.

Main Results:

  • Patients with Afib exhibited significantly greater beat-to-beat variability in maximal MA area (median absolute difference 1.8 cm²) compared to SR patients (0.8 cm²; P < 0.001).
  • Similarly, Afib patients showed higher beat-to-beat variability in maximal TA area (1.4 cm²) than SR patients (0.7 cm²; P < 0.001).
  • The timing of maximal annulus size demonstrated greater variability in Afib compared to SR for both MA and TA.

Conclusions:

  • Both mitral and tricuspid annuli display significant beat-to-beat size variability, with maximal size occurring within a broad temporal range.
  • Atrial fibrillation exacerbates this beat-to-beat variability in both the magnitude and timing of annulus size compared to sinus rhythm.
  • These findings underscore the importance of considering dynamic annular changes in Afib when planning percutaneous device implantation.
Abstract

Keywords:
atrial fibrillationbeat-to-beat variabilitymitral annuluspercutaneous interventionsthree-dimensional echocardiographytricuspid annulus

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