Skip to main content
Download PDF

Predictive value of various Doppler-derived parameters of atrial conduction time for successful atrial fibrillation ablation

Echo Research & Practice volume 2, pages 99–107 (2015)Cite this article

Abstract

Various Doppler-derived parameters of left atrial electrical remodeling have been demonstrated to predict recurrence of atrial fibrillation (AF) after AF ablation. The aim of this study was to compare three Doppler-derived measures of atrial conduction time in patients undergoing AF ablation, and to investigate their predictive value for successful procedure. In 32 prospectively enrolled patients undergoing the first AF ablation, atrial conduction time was estimated by measuring the time delay between the onset of P-wave on the surface ECG to the peak of the a′-wave on the pulsed-wave Doppler and color-coded tissue Doppler imaging of the left atrial lateral wall, and to the peak of the A-wave on the pulsed-wave Doppler of the mitral inflow. There was a significant difference in the baseline atrial conduction time measured by different echocardiographic techniques. Most (88%) patients had normal or only mildly dilated left atrium. At 6 months, 12 patients (38%) had recurrent AF/atrial tachycardia. The duration of history of AF was the only predictor of AF/atrial tachycardia recurrence following the first AF ablation (P=0.024; OR 1.023, CI 1.003–1.044). A combination of normal left atrial volume and history of paroxysmal AF of ≤48 months was associated with the best outcome. Predictive value of the Doppler derived parameters of atrial conduction time may be reduced in the early stages of left atrial remodeling. Future studies may determine which echocardiographic parameter correlates best with the extent of left atrial remodeling and is most predictive of successful AF ablation.

References

  1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, Hailpern SM, Ho M, Howard V, & Kissela B 2008 for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117 e25–e146. (doi:10.1161/CIRCULATIONAHA.107.187998)

    PubMed  Google Scholar 

  2. Wokhlu A, Hodge DO, Monahan KH, Asirvatham SJ, Friedman PA, Munger TM, Cha YM, Shen WK, Brady PA, Bluhm CM, et al. 2010 Long-term outcome of atrial fibrillation ablation: impact and predictors of very late recurrence. Journal of Cardiovascular Electrophysiology 21 1071–1078. (doi:10.1111/j.1540-8167.2010.01786.x)

    Article  PubMed  Google Scholar 

  3. Stabile G, Bertaglia E, Senatore G, De Simone A, Zoppo F, Donnici G, Turco P, Pascotto P, Fazzari M, & Vitale D 2006 Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation for The Cure of Atrial Fibrillation study). European Heart Journal 27 216–221. (doi:10.1093/eurheartj/ehi583)

    Article  PubMed  Google Scholar 

  4. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Packer D, & Skanes A 2005 Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 111 1100–1105. (doi:10.1161/01.CIR.0000157153.30978.67)

    Article  PubMed  Google Scholar 

  5. Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, Lellouche N, Knecht S, Wright M, & Nault I 2011 Catheter ablation for atrial fibrillation. Are results maintained at 5 years of follow-up? Journal of the American College of Cardiology 57 160–166. (doi:10.1016/j.jacc.2010.05.061)

    Article  PubMed  Google Scholar 

  6. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ, Jr, Davies DW, & DiMarco J 2012 HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints and research trial design. Europace 14 528–606. (doi:10.1093/europace/eus027)

    Article  PubMed  Google Scholar 

  7. Wijffels MC, Kirchhof CJ, Dorland R, & Allesie MA 1995 Atrial fibrillation begets atrial fibrillation: A study in awake chronically instrumented goats. Circulation 92 1954–1968. (doi:10.1161/01.CIR.92.7.1954)

    Article  CAS  PubMed  Google Scholar 

  8. Merckx KL, De Vos CB, Palmans A, Habets J, Cheriex EC, Crijns HJ, & Tieleman RG 2005 Atrial activation time determined by transthoracic Doppler tissue imaging can be used as an estimate of the total duration of atrial electrical activation. Journal of the American Society of Echocardiography 18 940–944. (doi:10.1016/j.echo.2005.03.022)

    Article  PubMed  Google Scholar 

  9. Den Uijl DW, Gawrysiak M, Tops LF, Trines SA, Zeppenfeld K, Schalij MJ, Bax JJ, & Delgado V 2011 Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace 13 1533–1540. (doi:10.1093/europace/eur186)

    Article  PubMed  Google Scholar 

  10. Ejima K, Kato K, Arai K, Fukushima K, Fukushima N, Suzuki T, Yoshida K, Nuki T, Uematsu S, Hoshi H, et al. 2014 Impact of atrial remodeling on the outcome of radiofrequency catheter ablation of paroxysmal atrial fibrillation. Circulation Journal 78 872–877. (doi:10.1253/circj.CJ-13-1391)

    Article  PubMed  Google Scholar 

  11. Mano H, Okumura Y, Watanabe I, Masakatsu O, Rikitake K, Naoko S, Toshiko N, Kimie O, Masayoshi K, Koichi N, et al. 2014 Changes over time in echocardiographic variables and atrial electromechanical intervals after ablation for atrial fibrillation. Journal of Arrhythmia 30 466–472. (doi:10.1016/j.joa.2014.01.005)

    Article  Google Scholar 

  12. Fukushima K, Fukushima N, Ejima K, Kato K, Sato Y, Uematsu S, Arai K, Manaka T, Takagi A, Ashihara K, et al. 2015 Left atrial appendage flow velocity and time from P-wave onset to tissue Doppler-derived a′ predict atrial fibrillation recurrence after radiofrequency catheter ablation. Echocardiography 32 1101–1108. (doi:10.1111/echo.12823)

    Article  PubMed  Google Scholar 

  13. Chao TF, Sung SH, Wang KL, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Suenari K, Li CH, et al. 2011 Association between the atrial electromechanical interval, atrial remodeling and outcome of catheter ablation in paroxysmal atrial fibrillation. Heart 97 225–230. (doi:10.1136/hrt.2010.212373)

    Article  PubMed  Google Scholar 

  14. Nishimura R, Miller FJ, Callahan M, Benassi RC, Seward JB, & Tajik AJ 1985 Doppler echocardiography: theory, instrumentation technique and application. Mayo Clinic Proceedings 60 321–343. (doi:10.1016/S0025-6196(12)60540-0)

    Article  CAS  PubMed  Google Scholar 

  15. Tajik A, Seward J, Hagler D, Mair DD, & Lie JT 1978 Two dimensional real-time ultrasonic imaging of the heart and great vessels: technique, image orientation, structure identification and validation. Mayo Clinic Proceedings 53 271–303. (doi:10.4250/jcu.2014.22.3.127)

    CAS  PubMed  Google Scholar 

  16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. 2015 Recommendations for chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography 28 1–39. (doi:10.1016/j.echo.2014.10.003)

    Article  PubMed  Google Scholar 

  17. Mosteller RD 1987 Simplified calculation of body-surface area. New England Journal of Medicine 317 1098 (doi:10.1056/NEJM198710223171717)

    Article  CAS  PubMed  Google Scholar 

  18. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, et al. 2003 Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. Journal of the American Society of Echocardiography 16 777–802. (doi:10.1016/S0894-7317(03)00335-3)

    Article  PubMed  Google Scholar 

  19. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, & Evangelista A 2009 Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Journal of the American Society of Echocardiography 22 107–133. (doi:10.1016/j.echo.2008.11.023)

    Article  PubMed  Google Scholar 

  20. Fukunami M, Yamada T, Ohmori M, Kumagai K, Umemoto K, Sakai A, Kondoh N, Minamino T, & Hoki N 1991 Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by P wave-triggered signal-averaged electrocardiogram. Circulation 83 162–169. (doi:10.1161/01.CIR.83.1.162)

    Article  CAS  PubMed  Google Scholar 

  21. Guidera SA, & Steinberg JS 1993 The signal-averaged P wave duration: a rapid and noninvasive marker of risk of atrial fibrillation. Journal of the American College of Cardiology 21 1645–1651. (doi:10.1016/0735-1097(93)90381-A)

    Article  CAS  PubMed  Google Scholar 

  22. Park SM, Kim YH, Choi JI, Pak HN, Kim YH, & Shim WJ 2010 Left atrial electromechanical conduction time can predict six-month maintenance of sinus rhythm after electrical cardioversion in persistent atrial fibrillation by Doppler tissue echocardiography. Journal of the American Society of Echocardiography 23 309–314. (doi:10.1016/j.echo.2009.12.019)

    Article  PubMed  Google Scholar 

  23. Maffé S, Paffoni P, Dellavesa P, Cucchi L, Zenone F, Bergamasco L, Paino AM, Franchetti Pardo N, Signorotti F, Baduena L, et al. 2015 Prognostic value of total atrial conduction time measured with tissue Doppler imaging to predict the maintenance of sinus rhythm after external electrical cardioversion of persistent atrial fibrillation. Echocardiography 32 420–427. (doi:10.1111/echo.12702)

    Article  PubMed  Google Scholar 

  24. Baek HK, Park TH, Park SY, Kim JH, Seo JM, Kim WJ, Nam YH, Kim MH, & Kim YD 2011 Determination of diastolic dysfunction cut-off value by tissue Doppler imaging in adults 70 years of age or older: a comparative analysis of pulsed-wave and color-coded tissue Doppler imaging. Korean Circulation Journal 41 137–142. (doi:10.4070/kcj.2011.41.3.137)

    Article  PubMed  PubMed Central  Google Scholar 

  25. McCulloch M, Zoghbi WA, Davis R, Thomas C, & Dokainish H 2006 Color tissue Doppler myocardial velocities consistently underestimate spectral tissue Doppler velocities: impact on calculation peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea′). Journal of the American Society of Echocardiography 19 744–748. (doi:10.1016/j.echo.2006.01.020)

    Article  PubMed  Google Scholar 

  26. Teh AW, Kistler PM, Lee G, Medi C, Heck PM, Spence SJ, Sparks PB, Morton JB, & Kalman JM 2012 Electroanatomic remodeling of the left atrium in paroxysmal and persistent atrial fibrillation patients without structural heart disease. Journal of Cardiovascular Electrophysiology 23 232–238. (doi:10.1111/j.1540-8167.2011.02178.x)

    Article  PubMed  Google Scholar 

  27. Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, & Gersh BJ 2007 Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation 115 3050–3056. (doi:10.1161/CIRCULATIONAHA.106.644484)

    Article  PubMed  Google Scholar 

  28. Wyse DG, & Gersh BJ 2004 Atrial fibrillation: a perspective: thinking inside and outside the box. Circulation 109 3089–3095. (doi:10.1161/01.CIR.0000132611.01101.DC)

    Article  PubMed  Google Scholar 

  29. Allessie M, Ausma J, & Schotten U 2002 Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovascular Research 54 230–246. (doi:10.1016/S0008-6363(02)00258-4)

    Article  CAS  PubMed  Google Scholar 

  30. Motoki H, Negishi K, Kusunose K, Popović ZB, Bhargava M, Wazni OM, Saliba WI, Chung MK, Marwick TH, & Klein AL 2014 Global left atrial strain in the prediction of sinus rhythm maintanance after catheter ablation for atrial fibrillation. Journal of the American Society of Echocardiography 27 1184–1192. (doi:10.1016/j.echo.2014.08.017)

    Article  PubMed  PubMed Central  Google Scholar 

  31. Montserrat S, Ganrielly L, Bijnens B, Borràs R, Berruezo A, Poyatos S, Brugada J, Mont L, & Sitges M 2015 Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation. Heart Rhythm 12 11–18. (doi:10.1016/j.hrthm.2014.08.032)

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the financial support from the University Hospital Foundation. We are grateful for the assistance from Sean Chiew andJoanne McGoey.

Funding

This work was supported by the University Hospital Foundation (2010).

Author information

Authors and Affiliations

  1. Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C. Mackenzie, 8440-112 Street, Alberta, Edmonton, T6G 2B7, Canada

    Miriam Shanks MD PhD, Lucas Valtuille MD CEPS, Jonathan B. Choy MD MBA FASE & Harald Becher MD PhD

Authors
  1. Miriam Shanks MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucas Valtuille MD CEPS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan B. Choy MD MBA FASE
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harald Becher MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miriam Shanks MD PhD.

Rights and permissions

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shanks, M., Valtuille, L., Choy, J.B. et al. Predictive value of various Doppler-derived parameters of atrial conduction time for successful atrial fibrillation ablation. Echo Res Pract 2, 99–107 (2015). https://doi.org/10.1530/ERP-15-0027

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-15-0027

Key Words

Echo Research & Practice

ISSN: 2055-0464

Contact us