Promporn Suksaranjit1, Nazem Akoum1, Eugene G Kholmovski2, Gregory J Stoddard3, Lowell Chang1, Kavitha Damal3, Krishna Velagapudi4, Allen Rassa4, Erik Bieging4, Shridhar Challa4, Imran Haider1, Nassir F Marrouche1, Christopher J McGann1, Brent D Wilson5. 1. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah. 2. Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah; Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah. 3. Division of Epidemiology, University of Utah, Salt Lake City, Utah. 4. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah. 5. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah. Electronic address: brent.wilson@hsc.utah.edu.
Abstract
OBJECTIVES: This study sought to evaluate the prognostic significance of left ventricular late gadolinium enhancement (LV-LGE) incidentally found in atrial fibrillation (AF) patients who undergo ablation therapy. BACKGROUND: LV-LGE provides prognostic information in patients with ischemic and nonischemic cardiomyopathies. However, data on the clinical significance of incidental LV-LGE in the AF population are limited. METHODS: A total of 778 patients who were referred for radiofrequency ablation of AF underwent cardiac magnetic resonance examinations between June 2006 and January 2013. Patients with a history of myocardial infarction or ablation therapy were excluded. The presence of LV-LGE was assessed by experienced imaging physicians. Patients were followed for arrhythmia recurrence after the radiofrequency ablation procedure. RESULTS: Of 598 patients included in the study, 60% were men with a mean age of 64 years and a median AF duration of 25 months. LV-LGE was detected in 39 patients (6.5%). There were 240 arrhythmia recurrences observed involving 40% of patients over a median follow-up period of 52 months. On univariate analysis, age (hazard ratio [HR]: 1.02; 95% confidence interval [CI]: 1.00 to 1.03), male sex (HR: 0.63; 95% CI: 0.47 to 0.86), diabetes (HR: 1.53; 95% CI: 1.03 to 2.27), CHADS2 score (HR: 1.19; 95% CI: 1.04 to 1.36), CHA2DS2-VASc score (HR: 1.18; 95% CI: 1.08 to 1.30), left atrial (LA) fibrosis (HR: 1.66; 95% CI: 1.41 to 1.96), LV-LGE (HR: 1.83; 95% CI: 1.11 to 3.03), persistent AF (HR: 1.52; 95% CI: 1.11 to 2.09), and LA area (HR: 1.03; 95% CI: 1.01 to 1.05) were significantly associated with arrhythmia recurrence. The recurrence rate was 69% in patients with LV-LGE compared with 38% in patients without LV-LGE (p < 0.001). In a multivariate model, LA fibrosis and LV-LGE were independent predictors of arrhythmia recurrence. CONCLUSIONS: In AF patients without history of myocardial infarction, LV-LGE is a significant independent predictor of arrhythmia recurrence after ablation therapy.
OBJECTIVES: This study sought to evaluate the prognostic significance of left ventricular late gadolinium enhancement (LV-LGE) incidentally found in atrial fibrillation (AF) patients who undergo ablation therapy. BACKGROUND: LV-LGE provides prognostic information in patients with ischemic and nonischemic cardiomyopathies. However, data on the clinical significance of incidental LV-LGE in the AF population are limited. METHODS: A total of 778 patients who were referred for radiofrequency ablation of AF underwent cardiac magnetic resonance examinations between June 2006 and January 2013. Patients with a history of myocardial infarction or ablation therapy were excluded. The presence of LV-LGE was assessed by experienced imaging physicians. Patients were followed for arrhythmia recurrence after the radiofrequency ablation procedure. RESULTS: Of 598 patients included in the study, 60% were men with a mean age of 64 years and a median AF duration of 25 months. LV-LGE was detected in 39 patients (6.5%). There were 240 arrhythmia recurrences observed involving 40% of patients over a median follow-up period of 52 months. On univariate analysis, age (hazard ratio [HR]: 1.02; 95% confidence interval [CI]: 1.00 to 1.03), male sex (HR: 0.63; 95% CI: 0.47 to 0.86), diabetes (HR: 1.53; 95% CI: 1.03 to 2.27), CHADS2 score (HR: 1.19; 95% CI: 1.04 to 1.36), CHA2DS2-VASc score (HR: 1.18; 95% CI: 1.08 to 1.30), left atrial (LA) fibrosis (HR: 1.66; 95% CI: 1.41 to 1.96), LV-LGE (HR: 1.83; 95% CI: 1.11 to 3.03), persistent AF (HR: 1.52; 95% CI: 1.11 to 2.09), and LA area (HR: 1.03; 95% CI: 1.01 to 1.05) were significantly associated with arrhythmia recurrence. The recurrence rate was 69% in patients with LV-LGE compared with 38% in patients without LV-LGE (p < 0.001). In a multivariate model, LA fibrosis and LV-LGE were independent predictors of arrhythmia recurrence. CONCLUSIONS: In AFpatients without history of myocardial infarction, LV-LGE is a significant independent predictor of arrhythmia recurrence after ablation therapy.
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