Christian Sohns1, Christine Lemes2, Andreas Metzner2, Thomas Fink2, Mikhail Chmelevsky2, Tilman Maurer2, Margarita Budanova2, Vladislav Solntsev2, Walther H W Schulze2, Wieland Staab2, Shibu Mathew2, Christian Heeger2, Bruno Reißmann2, Eugene Kholmovski2, Dietmar Kivelitz2, Feifan Ouyang2, Karl-Heinz Kuck2. 1. From the Department of Cardiology (C.S., C.L., A.M., T.F., T.M., S.M., C.H., B.R., F.O., K.-H.K.) and Department of Radiology (D.K.), Asklepios Klinik St. Georg, Hamburg, Germany; Department of Сardiac Electrophysiology (M.C., M.B.) and Department of Biostatistics (V.S.), Federal Almazov North-West Medical Research Centre, St-Petersburg, Russia; EP Solutions SA, Yverdon-les-Bains, Switzerland (M.C., W.H.W.S.); Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (W.S.); and Comprehensive Arrhythmia Research and Management Center, Salt Lake City, UT (E.K.). c.sohns@asklepios.com. 2. From the Department of Cardiology (C.S., C.L., A.M., T.F., T.M., S.M., C.H., B.R., F.O., K.-H.K.) and Department of Radiology (D.K.), Asklepios Klinik St. Georg, Hamburg, Germany; Department of Сardiac Electrophysiology (M.C., M.B.) and Department of Biostatistics (V.S.), Federal Almazov North-West Medical Research Centre, St-Petersburg, Russia; EP Solutions SA, Yverdon-les-Bains, Switzerland (M.C., W.H.W.S.); Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (W.S.); and Comprehensive Arrhythmia Research and Management Center, Salt Lake City, UT (E.K.).
Abstract
BACKGROUND: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can be used to evaluate characteristics of atrial fibrosis. The novel noninvasive epicardial and endocardial electrophysiology system (NEEES) allows for the identification of sources with rotor activity. This study describes a new technique to examine the relationship between rotors and LGE signal intensity in patients with persistent atrial fibrillation (PERS) scheduled for ablation. METHODS AND RESULTS: Ten consecutive patients underwent pulmonary vein isolation for persistent atrial fibrillation. LGE CMR of both atria was performed, and NEEES-based analysis was conducted to identify rotors. For each mapping point, the intracardiac locations were transferred onto an individual CMR-derived 3-dimensional shell. This allowed the LGE signal intensity to be projected onto the anatomy from the NEEES analysis. NEEES analysis identified a total number of 410 electric rotors, 47.8% were located in the left atrium and 52.2% in the right atrium. Magnetic resonance imaging analysis was performed from 10 right atria and 10 left atria data sets, including 86 axial LGE CMR planes per atrium. The mean LGE burden for left atrium and right atrium was 23.9±1.6% and 15.9±1.8%, respectively. Statistical analysis demonstrated a lack of regional association between the extent of LGE signal intensity and the presence of rotors. CONCLUSIONS: This is the first study demonstrating that the presence of rotors based on NEEES analysis is not directly associated with the extent and anatomic location of LGE signal intensity from CMR. Further studies evaluating the relationship between rotors and fibrosis in patients with persistent atrial fibrillation are mandatory and may inform strategies to improve ablation outcome.
BACKGROUND: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can be used to evaluate characteristics of atrial fibrosis. The novel noninvasive epicardial and endocardial electrophysiology system (NEEES) allows for the identification of sources with rotor activity. This study describes a new technique to examine the relationship between rotors and LGE signal intensity in patients with persistent atrial fibrillation (PERS) scheduled for ablation. METHODS AND RESULTS: Ten consecutive patients underwent pulmonary vein isolation for persistent atrial fibrillation. LGE CMR of both atria was performed, and NEEES-based analysis was conducted to identify rotors. For each mapping point, the intracardiac locations were transferred onto an individual CMR-derived 3-dimensional shell. This allowed the LGE signal intensity to be projected onto the anatomy from the NEEES analysis. NEEES analysis identified a total number of 410 electric rotors, 47.8% were located in the left atrium and 52.2% in the right atrium. Magnetic resonance imaging analysis was performed from 10 right atria and 10 left atria data sets, including 86 axial LGE CMR planes per atrium. The mean LGE burden for left atrium and right atrium was 23.9±1.6% and 15.9±1.8%, respectively. Statistical analysis demonstrated a lack of regional association between the extent of LGE signal intensity and the presence of rotors. CONCLUSIONS: This is the first study demonstrating that the presence of rotors based on NEEES analysis is not directly associated with the extent and anatomic location of LGE signal intensity from CMR. Further studies evaluating the relationship between rotors and fibrosis in patients with persistent atrial fibrillation are mandatory and may inform strategies to improve ablation outcome.
Authors: Uma Mahesh R Avula; Jeffrey Abrams; Alexander Katchman; Sergey Zakharov; Sergey Mironov; Joseph Bayne; Daniel Roybal; Anirudh Gorti; Lin Yang; Vivek Iyer; Marc Waase; Deepak Saluja; Edward J Ciaccio; Hasan Garan; Andrew R Marks; Steven O Marx; Elaine Y Wan Journal: JCI Insight Date: 2019-04-25
Authors: Marc D Lemoine; Thomas Fink; Celine Mencke; Ruben Schleberger; Ilaria My; Julius Obergassel; Leonard Bergau; Vanessa Sciacca; Laura Rottner; Julia Moser; Shinwan Kany; Fabian Moser; Paula Münkler; Leon Dinshaw; Paulus Kirchhof; Bruno Reissmann; Feifan Ouyang; Philipp Sommer; Christian Sohns; Andreas Rillig; Andreas Metzner Journal: Clin Res Cardiol Date: 2022-09-22 Impact factor: 6.138
Authors: Aleksei V Mikhailov; Anuradha Kalyanasundaram; Ning Li; Shane S Scott; Esthela J Artiga; Megan M Subr; Jichao Zhao; Brian J Hansen; John D Hummel; Vadim V Fedorov Journal: J Mol Cell Cardiol Date: 2020-10-29 Impact factor: 5.000