Markus Linhart1,2, Francisco Alarcon1,2, Roger Borràs1,2, Eva M Benito1,2,3, Fredy Chipa1,2, Jennifer Cozzari1,2, Gala Caixal1,2, Norihiro Enomoto1,2, Alicia Carlosena1,2, Eduard Guasch1,2,3,4, Elena Arbelo2,3,4, Jose Maria Tolosana1,2,4, Susana Prat-Gonzalez1,2,3, Rosario J Perea1,2, Adelina Doltra1,2, Marta Sitges1,2,3,4, Josep Brugada1,2,3,4, Antonio Berruezo1,2,4, Lluís Mont1,2,3,4. 1. Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.). 2. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.). 3. Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.). 4. CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.).
Abstract
BACKGROUND: There is limited knowledge about the impact of anatomic gaps as assessed by delayed gadolinium enhancement cardiac magnetic resonance on atrial fibrillation (AF) recurrence after first pulmonary vein (PV) isolation. METHODS: Consecutive patients underwent delayed gadolinium enhancement cardiac magnetic resonance 3 months after radiofrequency circumferential PV isolation. Delayed gadolinium enhancement cardiac magnetic resonance images were assessed from 360 PV resulting in 2880 segments in the 2×8-segment model from 94 patients (52±11 years, 62% paroxysmal AF). Left atria were segmented using dedicated software. Anatomic gap was defined as discontinuation of the ablation line by ≥3 mm. Relative gap length was calculated as absolute gap length divided by the total length of the ablation line. AF recurrence was assessed after a mean follow-up duration of 15±10 months Results: Mean number of anatomic gaps was 5.4 per patient. Recurrence within the first year of ablation was observed in 21 patients with paroxysmal AF (36%) and 19 patients with persistent AF (53%). In the univariate analysis, CHA2DS2-VASc score, AF type, and relative gap length were predictive of recurrence. In the multivariate analysis, only relative gap length was significantly associated with recurrence (hazard ratio, 1.16 [1.02-1.31] per each 10% of gap). CONCLUSIONS: The total relative gap length but not the number of anatomic gaps in the PV ablation line as assessed by delayed gadolinium enhancement cardiac magnetic resonance was associated with AF recurrence 1 year after first PV isolation. An increase of 10% relative gap length increased the likelihood of AF recurrence by 16%.
BACKGROUND: There is limited knowledge about the impact of anatomic gaps as assessed by delayed gadolinium enhancement cardiac magnetic resonance on atrial fibrillation (AF) recurrence after first pulmonary vein (PV) isolation. METHODS: Consecutive patients underwent delayed gadolinium enhancement cardiac magnetic resonance 3 months after radiofrequency circumferential PV isolation. Delayed gadolinium enhancement cardiac magnetic resonance images were assessed from 360 PV resulting in 2880 segments in the 2×8-segment model from 94 patients (52±11 years, 62% paroxysmal AF). Left atria were segmented using dedicated software. Anatomic gap was defined as discontinuation of the ablation line by ≥3 mm. Relative gap length was calculated as absolute gap length divided by the total length of the ablation line. AF recurrence was assessed after a mean follow-up duration of 15±10 months Results: Mean number of anatomic gaps was 5.4 per patient. Recurrence within the first year of ablation was observed in 21 patients with paroxysmal AF (36%) and 19 patients with persistent AF (53%). In the univariate analysis, CHA2DS2-VASc score, AF type, and relative gap length were predictive of recurrence. In the multivariate analysis, only relative gap length was significantly associated with recurrence (hazard ratio, 1.16 [1.02-1.31] per each 10% of gap). CONCLUSIONS: The total relative gap length but not the number of anatomic gaps in the PV ablation line as assessed by delayed gadolinium enhancement cardiac magnetic resonance was associated with AF recurrence 1 year after first PV isolation. An increase of 10% relative gap length increased the likelihood of AF recurrence by 16%.
Entities:
Keywords:
atrial fibrillation; magnetic resonance imaging; pulmonary veins
Authors: Caroline H Roney; Charles Sillett; John Whitaker; Jose Alonso Solis Lemus; Iain Sim; Irum Kotadia; Mark O'Neill; Steven E Williams; Steven A Niederer Journal: Eur Heart J Cardiovasc Imaging Date: 2021-12-18 Impact factor: 6.875
Authors: Sophie Paddock; Vasiliki Tsampasian; Hosamadin Assadi; Bruno Calife Mota; Andrew J Swift; Amrit Chowdhary; Peter Swoboda; Eylem Levelt; Eva Sammut; Amardeep Dastidar; Jordi Broncano Cabrero; Javier Royuela Del Val; Paul Malcolm; Julia Sun; Alisdair Ryding; Chris Sawh; Richard Greenwood; David Hewson; Vassilios Vassiliou; Pankaj Garg Journal: Front Cardiovasc Med Date: 2021-07-07