Nazem Akoum1, David Wilber2, Gerhard Hindricks3, Pierre Jais4, Josh Cates5, Francis Marchlinski6, Eugene Kholmovski5, Nathan Burgon5, Nan Hu5, Lluis Mont7, Thomas Deneke8, Mattias Duytschaever9, Thomas Neumann10, Moussa Mansour11, Christian Mahnkopf12, Mathew Hutchinson4, Bengt Herweg13, Emile Daoud14, Erik Wissner15, Johannes Brachmann12, Nassir F Marrouche5. 1. Atrial Fibrillation Program, University of Washington, Seattle, Washington, USA. 2. Loyola University Medical Center, Illinois, USA. 3. University of Leipzig, Germany. 4. Centre Hospitalier Universitaire de Bordeaux, France. 5. Comprehensive Arrhythmia and Research Management (CARMA) Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. 6. Hospital of the University of Pennsylvania, Pennsylvania, USA. 7. Hospital Clinic, Universiat de Barcelona, Institut d'investigació Biomèdica August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. 8. BG-Kliniken Bergmannsheil, University of Bochum, Germany. 9. University Hospital Ghent, Belgium. 10. Kerckhoff Heart Center, Germany. 11. Massachusetts General Hospital, Massachusetts, USA. 12. Klinikum Coburg, II. Medizinische Klinik, Germany. 13. USF Morsani College of Medicine, Florida, USA. 14. Ohio State University, Ohio, USA. 15. Asklepios Klinik St. Georg, Germany.
Abstract
BACKGROUND: There is limited knowledge on the extent and location of scarring that results from catheter ablation and its role in suppressing atrial fibrillation (AF). We examined the effect of atrial fibrosis and ablation-induced scarring on catheter ablation outcomes in AF. METHODS: We conducted a prospective multicenter study that enrolled 329 AF patients presenting for catheter ablation. Delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium was obtained preablation. Scarring was evaluated in 177 patients with a DE-MRI scan obtained 90 days postablation. We evaluated residual fibrosis, defined as preablation atrial fibrosis not covered by ablation scar. The primary outcome was freedom from recurrent atrial arrhythmia. RESULTS: In the analysis cohort of 177 patients, preablation fibrosis was 18.7 ± 8.7% of the atrial wall. Ablation aimed at pulmonary vein (PV) isolation was performed in 163 patients (92.1%). Ablation-induced scar averaged 10.6 ± 4.4% of the atrial wall. Scarring completely encircled all 4 PVs only in 12 patients (7.3%). Residual fibrosis was calculated at 15.8 ± 8.0%. At 325 days follow-up, 35% of patients experienced recurrent arrhythmia. Multivariable Cox proportional hazards models demonstrated that baseline atrial fibrosis (HR and 95% CIs) (1.09 [1.06-1.12], P < 0.001) and residual fibrosis (1.09 [1.05-1.13], P < 0.001) were associated with atrial arrhythmia recurrence, while PV encirclement and overall scar were not. CONCLUSIONS: Catheter ablation of AF targeting PVs rarely achieves permanent encircling scar in the intended areas. Overall atrial fibrosis present at baseline and residual fibrosis uncovered by ablation scar are associated with recurrent arrhythmia.
BACKGROUND: There is limited knowledge on the extent and location of scarring that results from catheter ablation and its role in suppressing atrial fibrillation (AF). We examined the effect of atrial fibrosis and ablation-induced scarring on catheter ablation outcomes in AF. METHODS: We conducted a prospective multicenter study that enrolled 329 AFpatients presenting for catheter ablation. Delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium was obtained preablation. Scarring was evaluated in 177 patients with a DE-MRI scan obtained 90 days postablation. We evaluated residual fibrosis, defined as preablation atrial fibrosis not covered by ablation scar. The primary outcome was freedom from recurrent atrial arrhythmia. RESULTS: In the analysis cohort of 177 patients, preablation fibrosis was 18.7 ± 8.7% of the atrial wall. Ablation aimed at pulmonary vein (PV) isolation was performed in 163 patients (92.1%). Ablation-induced scar averaged 10.6 ± 4.4% of the atrial wall. Scarring completely encircled all 4 PVs only in 12 patients (7.3%). Residual fibrosis was calculated at 15.8 ± 8.0%. At 325 days follow-up, 35% of patients experienced recurrent arrhythmia. Multivariable Cox proportional hazards models demonstrated that baseline atrial fibrosis (HR and 95% CIs) (1.09 [1.06-1.12], P < 0.001) and residual fibrosis (1.09 [1.05-1.13], P < 0.001) were associated with atrial arrhythmia recurrence, while PV encirclement and overall scar were not. CONCLUSIONS: Catheter ablation of AF targeting PVs rarely achieves permanent encircling scar in the intended areas. Overall atrial fibrosis present at baseline and residual fibrosis uncovered by ablation scar are associated with recurrent arrhythmia.
Authors: Nassir F Marrouche; Oussama Wazni; Christopher McGann; Tom Greene; J Michael Dean; Lilas Dagher; Eugene Kholmovski; Moussa Mansour; Francis Marchlinski; David Wilber; Gerhard Hindricks; Christian Mahnkopf; Darryl Wells; Pierre Jais; Prashanthan Sanders; Johannes Brachmann; Jeroen J Bax; Leonie Morrison-de Boer; Thomas Deneke; Hugh Calkins; Christian Sohns; Nazem Akoum Journal: JAMA Date: 2022-06-21 Impact factor: 157.335
Authors: Mohammadali Habibi; Joao A C Lima; Esra Gucuk Ipek; David Spragg; Hiroshi Ashikaga; Joseph E Marine; Ronald D Berger; Hugh Calkins; Saman Nazarian Journal: J Cardiovasc Electrophysiol Date: 2020-12-29
Authors: Francesco De Sensi; Diego Penela; David Soto-Iglesias; Antonio Berruezo; Ugo Limbruno Journal: J Clin Med Date: 2021-05-24 Impact factor: 4.241