Abstract 12327: The Characteristics of Pulmonary Vein Remodeling in Stroke with Non-valvular Atrial Fibrillation

Abstract

Background: Structural remodeling plays an important role in the genesis and maintenance of atrial fibrillation (AF). Although some studies that associate structural remodeling with atrial dilation have been reported, the effect of pulmonary vein (PV) structural remodeling and dilation on the stroke in AF patients remains unknown. This study investigated the characteristics of PV remodeling in stroke with non-valvular AF patients.

Methods: We studied control (Group 1, n=130), non-valvular AF patients without non-hemorrhagic stroke (Group 2, n=134) and non-valvular AF patients with non-hemorrhagic stroke (Group 3, n=82). LA and PVs were measured using 3-dimensional computed tomography.

Results: Group 3 was older than group 2 (p<0.001) and 1 (p<0.001). CHA₂DS₂-VASc score was also higher in group 3 than in group 1 and 2. For groups 1, 2 and 3, respectively, the mean LA volume was 103 ± 26 ml, 143 ± 43 ml and 173 ± 54 ml (p<0.001), and the orifice area of left PVs was 4.4 ± 1.3 cm², 5.3 ± 1.4 cm² and 6.4 ± 2.3 cm²(p<0.001), suggesting progressive LA and left PV structural remodeling from AF to stroke. Moreover, LA volume and the orifice area of left PVs were larger in group 3 than 2 (p<0.001 for all). However, right PVs were not different between group 2 (7.0 ± 2.1 cm²) and 3 (6.6 ± 2.4 cm², p=0.19).

Conclusion: The left sided PVs undergo more significant structural remodeling and dilation in AF patients with stroke than control and even AF only patients. This change was closely related with the LA dilation. However, the right sided PVs showed no difference between AF patients with stroke and without stroke.