Related Experiment Video
Updated: Sep 17, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Heart-aorta-angle correlates left atrial low voltage areas formation in hypertensive atrial fibrillation patients
Guanqi Fan1,2,3,4, Yuhang Yang1,2,3, Tongshuai Chen1,2,3
1State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
Insights
Hypertension in atrial fibrillation (AF) patients is linked to smaller heart-aorta angles and increased low voltage areas (LVAs) in the left atrium. This suggests a mechanical interaction contributing to atrial fibrosis and AF recurrence.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- The mechanism of low voltage areas (LVAs) formation in hypertensive atrial fibrillation (AF) patients remains unclear.
- Hypertension is a common comorbidity in AF patients, influencing atrial substrate characteristics.
Purpose of the Study:
- To investigate atrial substrate characteristics in hypertensive AF patients.
- To explore the potential mechanism of abnormal LVAs formation related to the heart-aorta angle (HAA).
Main Methods:
- Observational cohort study including 93 AF patients undergoing coronary computed tomography angiography (CCTA) and catheter ablation.
- Patients were categorized into hypertensive and normotensive groups.
- Analysis included LVAs mapping, CCTA-measured HAA, and aortic sinus dimensions.
Main Results:
- Hypertensive patients exhibited a smaller ascending aorta-left atrium (AAo-LA) angle and larger ascending aorta-left ventricular (AAo-LV) angle compared to normotensive patients.
- A larger total LVAs area in the left atrium, particularly on the anterior wall, was observed in the hypertensive group.
- Smaller AAo-LA angle and larger AAo-LV angle, NCC diameter, and NCC-commissure distance were associated with increased anterior wall LVAs.
Conclusions:
- A smaller AAo-LA angle is characteristic of hypertensive AF patients, potentially increasing mechanical contact and contributing to LVAs formation.
- These findings suggest a link between cardiac geometry, LVAs, and atrial fibrosis in hypertensive AF.
- The observed anatomical differences may play a role in AF recurrence in hypertensive individuals.
Background:
The mechanism of low voltage areas (LVAs) formation in hypertensive atrial fibrillation (AF) patients is not clear. This observational study aimed to investigate the characteristics of atrial substrate in hypertensive AF patients and potential mechanism for abnormal LVAs formation related to heart-aorta-angle (HAA).
Methods:
It was an observational cohort study. From June 2022 to September 2023, AF patients who underwent coronary computed tomography angiography (CCTA) and catheter ablation were included and assigned into hypertensive or normotensive group. The distribution of LVAs mapping in left atrium, CCTA measured HAA, and dimension of aortic sinus were brought into analysis.
Results:
Forty-Eight of 93 patients (51.6%) (mean age, 62.63±10.01 years; 54 men) had long-standing hypertension. CCTA scan analysis showed hypertensive group (vs. normotensive group) had smaller ascending aorta-left atrium (AAo-LA) angle [mean ± standard deviation (SD), 29.11°±2.87° vs. 31.83°±2.04°, P<0.001], greater ascending aorta-left ventricular (AAo-LV) angle [median (interquartile range), 132.22° (129.80°-134.59°) vs. 129.33° (127.38°-131.87°), P<0.001], larger non-coronary cusp (NCC) diameter [20.80 (19.37, 21.71) vs. 19.11 (17.66, 19.69) mm, P<0.001], and larger NCC-commissure distance (34.85±2.57 vs. 33.54±2.14 mm, P=0.009). LVAs mapping results showed a larger total LVAs area in left atrium [19.11 (16.36, 20.13) vs. 15.63 (14.35, 18.04) cm2, P<0.001], especially in anterior wall (AW) in hypertensive group [5.11 (3.03, 5.75) vs. 3.42 (2.35, 4.42) cm2, P<0.001]. The AAo-LV angle (r=0.233, P=0.024), NCC diameter (r=0.324, P=0.002), and NCC-commissure distance (r=0.274, P=0.008) were positively related with AW-LVAs, and AAo-LA angle correlated negatively with AW-LVAs (r=-0.358, P<0.001). During a follow-up of 12 months, AF recurred in 16 patients (33.3%) in hypertensive group and in 7 patients (15.6%) in normotensive group (P=0.041).
Conclusions:
In AF patients with hypertension, smaller AAo-LA angle is common. The closer AAo-LA interaction relationship may increase the mechanical contact, which relates to LVAs formation in left atrium and contribute to the atrial fibrosis in hypertensive AF patients.
More Related Videos
09:17High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
Published on: July 29, 2011
04:48Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias