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Atrial Fibrillation Ablation Outcome is Predicted by Left Atrial Remodeling on MRI

Institution:
1Comprehensive Arrhythmia Research and Management Center, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
2Division of Cardiology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
3Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
4Department of Radiology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
5Scientific Computing and Imaging Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
6Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
7Division of Epidemiology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
Publication Date:
Feb-2014
Journal:
Circ Arrhythm Electrophysiol
Volume Number:
7
Issue Number:
1
Pages:
23-30
Citation:
Circ Arrhythm Electrophysiol. 2014 Feb;7(1):23-30.
PubMed ID:
24363354
PMCID:
PMC4086672
Keywords:
Atrial Remodeling, Catheter Ablation, Magnetic Resonance Imaging
Appears in Collections:
NA-MIC
Sponsors:
P41 RR012553/RR/NCRR NIH HHS/United States
P41 GM103545/GM/NIGMS NIH HHS/United States
U54 EB005149/EB/NIBIB NIH HHS/United States
Generated Citation:
McGann C., Akoum N., Patel A., Kholmovski E., Revelo P., Damal K., Wilson B., Cates J., Harrison A., Ranjan R., Burgon N.S., Greene T., Kim D., Dibella E.V.R., Parker D., Macleod R.S., Marrouche N.F. Atrial Fibrillation Ablation Outcome is Predicted by Left Atrial Remodeling on MRI. Circ Arrhythm Electrophysiol. 2014 Feb;7(1):23-30. PMID: 24363354. PMCID: PMC4086672.
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Although catheter ablation therapy for atrial fibrillation (AF) is becoming more common, results vary widely, and patient selection criteria remain poorly defined. We hypothesized that late gadolinium enhancement MRI (LGE-MRI) can identify left atrial (LA) wall structural remodeling (SRM) and stratify patients who are likely or not to benefit from ablation therapy. METHODS AND RESULTS: LGE-MRI was performed on 426 consecutive patients with AF without contraindications to MRI before undergoing their first ablation procedure and on 21 non-AF control subjects. Patients were categorized by SRM stage (I-IV) based on the percentage of LA wall enhancement for correlation with procedure outcomes. Histological validation of SRM was performed comparing LGE-MRI with surgical biopsy. A total of 386 patients (91%) with adequate LGE-MRI scans were included in the study. After ablation, 123 patients (31.9%) experienced recurrent atrial arrhythmias during the 1-year follow-up. Recurrent arrhythmias (failed ablations) occurred at higher SRM stages with 28 of 133 (21.0%) in stage I, 40 of 140 (29.3%) in stage II, 24 of 71 (33.8%) in stage III, and 30 of 42 (71.4%) in stage IV. In multivariate analysis, ablation outcome was best predicted by advanced SRM stage (hazard ratio, 4.89; P<0.0001) and diabetes mellitus (hazard ratio, 1.64; P=0.036), whereas increased LA volume and persistent AF were not significant predictors. LA wall enhancement was significantly greater in patients with AF versus non-AF controls (16.6±11.2% versus 3.1±1.9%; P<0.0001). Histological evidence of remodeling from surgical biopsy specimens correlated with SRM on LGE-MRI. CONCLUSIONS: Atrial SRM is identified on LGE-MRI, and extensive LGE (≥30% LA wall enhancement) predicts poor response to catheter ablation therapy for AF.

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