Department of Cardiology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.
J Am Heart Assoc. 2023 Aug;12(15):e028014. doi: 10.1161/JAHA.122.028014. Epub 2023 Jul 25.
Background Among patients with an implantable cardioverter-defibrillator, a high prevalence of atrial fibrillation (AF) is present. Identification of AF predictors in this patient group is of clinical importance to initiate appropriate preventive therapeutic measures to reduce the risk of AF-related complications. This study assesses whether cardiac magnetic resonance imaging-derived atrial characteristics are associated with AF development in patients with a dual-chamber implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator, as detected by the cardiac implantable electronic device. Methods and Results This single-center retrospective study included 233 patients without documented AF history at the moment of device implantation (dual-chamber implantable cardioverter-defibrillator [63.5%] or cardiac resynchronization therapy defibrillator [36.5%]). All patients underwent cardiac magnetic resonance imaging before device implantation. Cardiac magnetic resonance-derived features of left atrial (LA) remodeling were evaluated in all patients. Detection of AF episodes was based on cardiac implantable electronic device interrogation. During a median follow-up of 6.1 years, a newly diagnosed AF episode was detected in 88 of the 233 (37.8%) patients with an ICD. In these patients, increased LA volumes and impaired LA function (LA emptying fraction and LA strain) were found as compared with patients without AF during follow-up. However, a significant association was only found in patients with dilated cardiomyopathy and not in patients with ischemic cardiomyopathy. Conclusions LA remodeling characteristics were associated with development of AF in patients with dilated cardiomyopathy but not patients with ischemic cardiomyopathy, suggesting different mechanisms of AF development in ischemic cardiomyopathy and dilated cardiomyopathy. Assessment of LA remodeling before device implantation might identify high-risk patients for AF.
在植入式心脏复律除颤器（ICD）患者中，心房颤动（AF）的患病率较高。在该患者群体中识别 AF 的预测因素对于启动适当的预防性治疗措施以降低 AF 相关并发症的风险具有重要的临床意义。本研究评估了心脏磁共振成像（CMR）衍生的心房特征是否与植入双腔 ICD 或心脏再同步治疗除颤器（CRT-D）患者的 AF 发展相关，这些特征由心脏植入式电子设备（CIED）检测到。
本单中心回顾性研究纳入了 233 例在装置植入时无记录 AF 病史的患者（双腔 ICD [63.5%]或 CRT-D [36.5%]）。所有患者在装置植入前均进行 CMR 检查。所有患者均评估了左心房（LA）重构的 CMR 特征。基于 CIED 询问来检测 AF 发作。在中位随访 6.1 年期间，在 233 例 ICD 患者中有 88 例（37.8%）新诊断出 AF 发作。与随访期间未发生 AF 的患者相比，这些患者的 LA 容积增加和 LA 功能受损（LA 排空分数和 LA 应变）。然而，仅在扩张型心肌病患者中发现了显著相关性，而在缺血性心肌病患者中则没有。
LA 重构特征与扩张型心肌病患者 AF 的发生相关，但与缺血性心肌病患者无关，这表明缺血性心肌病和扩张型心肌病中 AF 发生的机制不同。在装置植入前评估 LA 重构可能有助于识别发生 AF 的高危患者。
