Ibolya Csécs1, Takanori Yamaguchi2, Mobin Kheirkhahan3, Csilla Czimbalmos4, Franziska Fochler3, Eugene G Kholmovski5, Alan K Morris3, Gagandeep Kaur3, Hajnalka Vago4, Bela Merkely4, Mihail G Chelu6, Nassir F Marrouche7, Brent D Wilson8. 1. Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, UT, USA; Heart and Vascular Center, Semmelweis University, Hungary. 2. Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, UT, USA; Department of Cardiovascular Medicine, Saga University, Japan. 3. Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, UT, USA. 4. Heart and Vascular Center, Semmelweis University, Hungary. 5. Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, UT, USA; Department of Radiology and Imaging Sciences, University of Utah, USA; Utah Center for Advanced Imaging Research, University of Utah, USA. 6. Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, UT, USA; Division of Cardiovascular Medicine, University of Utah, USA. 7. Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, UT, USA; Division of Cardiovascular Medicine, University of Utah, USA; Division of Cardiology, Heart and Vascular Institute, Tulane University, USA. 8. Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, UT, USA; Division of Cardiovascular Medicine, University of Utah, USA. Electronic address: brent.wilson@hsc.utah.edu.
Abstract
INTRODUCTION: Left atrial (LA) volumes are related to success of atrial fibrillation (AF) ablation, but the relation to other functional and structural parameters is less well understood. Our goal was to detect potential functional and structural predictors of arrhythmia recurrence after ablation using cardiac magnetic resonance imaging (CMRi) and to non-invasively assess the relation between LA functional and structural remodeling pre- and post-ablation. METHODS: A total of 55 patients (38 male, age 67 ± 10 years) underwent CMRi prior to and then within 24-h and 3-months after ablation. LA volumes (LAV) and function (as assessed by ejection fraction and peak longitudinal atrial strain (PLAS)) were measured by feature-tracking CMRi, and LA fibrosis/scarring was quantified using late‑gadolinium enhancement (LGE) imaging. RESULTS: Atrial function was lower acutely in patients with recurrence versus those with non-recurrence: [R vs NR: EFTotal 27.8 ± 10.3% vs 38.1 ± 11% p = 0.002; EFActive 10.5 ± 8% vs 19.1 ± 12% p = 0.007; EFPassive 19.4 ± 8 vs 25.8 ± 10 p = 0.021; PLAS 13 ± 5.9% vs 20.2 ± 7% p = 0.004]. With univariate analysis, baseline minimum volume (MinLAV, MinLAVi), several baseline functional parameters (EFTotal, EFPassive, EFActive, PLAS), and LA-LGE were predictors of recurrence [all p < 0.05]. Acute function (EFTotal, EFPassive, EFActive, PLAS) also predicted recurrence (p < 0.01). Lower pre-ablation EFTotal, EFPassive, and PLAS correlated with higher amount of pre-ablation LA-LGE (p < 0.05). In a multivariate model including MinLAV, EFActive and LA-LGE (all at baseline), LA-LGE was the only independent predictor of recurrence (p = 0.0322). CONCLUSION: Pre-ablation function inversely correlated with LA-LGE and was related to success of AF ablation. Multi-parametric and longitudinal assessment of LA function and structure could be helpful in selection of optimal treatment strategies for AF patients by predicting outcomes.
INTRODUCTION: Left atrial (LA) volumes are related to success of atrial fibrillation (AF) ablation, but the relation to other functional and structural parameters is less well understood. Our goal was to detect potential functional and structural predictors of arrhythmia recurrence after ablation using cardiac magnetic resonance imaging (CMRi) and to non-invasively assess the relation between LA functional and structural remodeling pre- and post-ablation. METHODS: A total of 55 patients (38 male, age 67 ± 10 years) underwent CMRi prior to and then within 24-h and 3-months after ablation. LA volumes (LAV) and function (as assessed by ejection fraction and peak longitudinal atrial strain (PLAS)) were measured by feature-tracking CMRi, and LA fibrosis/scarring was quantified using late‑gadolinium enhancement (LGE) imaging. RESULTS: Atrial function was lower acutely in patients with recurrence versus those with non-recurrence: [R vs NR: EFTotal 27.8 ± 10.3% vs 38.1 ± 11% p = 0.002; EFActive 10.5 ± 8% vs 19.1 ± 12% p = 0.007; EFPassive 19.4 ± 8 vs 25.8 ± 10 p = 0.021; PLAS 13 ± 5.9% vs 20.2 ± 7% p = 0.004]. With univariate analysis, baseline minimum volume (MinLAV, MinLAVi), several baseline functional parameters (EFTotal, EFPassive, EFActive, PLAS), and LA-LGE were predictors of recurrence [all p < 0.05]. Acute function (EFTotal, EFPassive, EFActive, PLAS) also predicted recurrence (p < 0.01). Lower pre-ablation EFTotal, EFPassive, and PLAS correlated with higher amount of pre-ablation LA-LGE (p < 0.05). In a multivariate model including MinLAV, EFActive and LA-LGE (all at baseline), LA-LGE was the only independent predictor of recurrence (p = 0.0322). CONCLUSION: Pre-ablation function inversely correlated with LA-LGE and was related to success of AF ablation. Multi-parametric and longitudinal assessment of LA function and structure could be helpful in selection of optimal treatment strategies for AFpatients by predicting outcomes.
Authors: Sotirios Nedios; Frank Lindemann; Jordi Heijman; Harry J G M Crijns; Andreas Bollmann; Gerhard Hindricks Journal: Herz Date: 2021-07-05 Impact factor: 1.443
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: Marjan Firouznia; Albert K Feeny; Michael A LaBarbera; Meghan McHale; Catherine Cantlay; Natalie Kalfas; Paul Schoenhagen; Walid Saliba; Patrick Tchou; John Barnard; Mina K Chung; Anant Madabhushi Journal: Circ Arrhythm Electrophysiol Date: 2021-02-12
Authors: Luuk H G A Hopman; Mark J Mulder; Anja M van der Laan; Ahmet Demirkiran; Pranav Bhagirath; Albert C van Rossum; Cornelis P Allaart; Marco J W Götte Journal: J Cardiovasc Magn Reson Date: 2021-11-11 Impact factor: 5.364