Acute response and rhythm outcome after the patchy late-gadolinium enhancement site catheter ablation in patients with persistent atrial fibrillation

Abstract Atrial remodeling with fibrosis has been well-described in patients with atrial fibrillation (AF). We hypothesized that the left atrial (LA)-late gadolinium enhancement (LGE) extent on cardiac magnetic resonance (CMR) imaging is associated with LA pressure and can be a marker for suitable candidates for non-paroxysmal AF ablation. A total of 173 AF patients with an LA-LGE area on CMR imaging were enrolled. The clinical parameters, including invasively measured LA pressure, were compared between the patients with extensive LA-LGE (E-LGE, LGE extent ≥ 20%, n = 78) and those with small LA-LGE (S-LGE, LGE extent < 20%, n = 95). The E-LGE group had higher peak LA pressures than the S-LGE group (23 versus 19 mmHg, p < 0.001). The E-LGE group had more patients with non-paroxysmal AF (non-PAF) (51% vs. 34%), heart failure (9% vs. 0%), and higher NT pro-B-type natriuretic peptide (472 vs. 265 pg/ml) (all p < 0.05). LA pressure ≥ 21 mmHg was an independent predictor of E-LGE (OR = 2.218; p = 0.019). In the paroxysmal AF (PAF) subgroup, freedom from atrial arrhythmia after catheter ablation was not different (81% vs 86%, log-rank p = 0.529). However, in the non-PAF subgroup, it was significantly higher in the S-LGE group than in the E-LGE group (81% vs 55%, log-rank p = 0.014). Increased LA pressure was related to the LA-LGE extent. LA-LGE was a good predictor of outcome after catheter ablation, but only in patients with non-PAF.

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The impact of the atrial wall thickness in normal/mild late‐gadolinium enhancement areas on atrial fibrillation rotors in persistent atrial fibrillation patients

Journal of Arrhythmia ◽

10.1002/joa3.12676 ◽

2022 ◽

Author(s):

Toshihiro Nakamura ◽

Kunihiko Kiuchi ◽

Koji Fukuzawa ◽

Mitsuru Takami ◽

Yoshiaki Watanabe ◽

...

Keyword(s):

Atrial Fibrillation ◽

Late Gadolinium Enhancement ◽

Wall Thickness ◽

Persistent Atrial Fibrillation ◽

Atrial Wall ◽

Gadolinium Enhancement ◽

The Impact

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P5222Cardiac magnetic resonance using late gadolinium enhancement imaging and T1 mapping predicts poor outcome in patients with atrial fibrillation after catheter ablation therapy

European Heart Journal ◽

10.1093/eurheartj/ehx493.p5222 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

J. Luetkens ◽

C. Wolpers ◽

T. Beiert ◽

H. Meendermann ◽

N. Daye ◽

...

Keyword(s):

Atrial Fibrillation ◽

Late Gadolinium Enhancement ◽

Catheter Ablation ◽

Magnetic Resonance ◽

T1 Mapping ◽

Late Gadolinium Enhancement Imaging ◽

Gadolinium Enhancement ◽

Ablation Therapy ◽

Poor Outcome

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Prospective evaluation of left atrial function and late gadolinium enhancement with 3 T MRI in patients with atrial fibrillation before and after catheter ablation

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-018-1455-5 ◽

2018 ◽

Vol 35 (3) ◽

pp. 499-504 ◽

Cited By ~ 2

Author(s):

Adrian Curta ◽

Stephanie Fichtner ◽

Reza Wakili ◽

Heidi Estner ◽

Harald Kramer

Keyword(s):

Atrial Fibrillation ◽

Late Gadolinium Enhancement ◽

Catheter Ablation ◽

Left Atrial ◽

Atrial Function ◽

Left Atrial Function ◽

Prospective Evaluation ◽

Gadolinium Enhancement ◽

Before And After

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P5657Fibrosis detected by late-gadolinium enhancement cardiac MRI is associated with atrial fibrillation and poorer ablation outcome: A meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0600 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T A Agbaedeng ◽

M Emami ◽

D A Munawar ◽

T Rattanakosit ◽

K I Khadim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Late Gadolinium Enhancement ◽

Catheter Ablation ◽

Cardiac Mri ◽

Meta Analysis ◽

Ventricular Wall ◽

Gadolinium Enhancement ◽

Increased Risk ◽

Lge Cmr ◽

Af Recurrence

Abstract Background Fibrosis is a hallmark of atrial fibrillation (AF) substrate. Recent data suggests that fibrosis detected by late-gadolinium enhancement (LGE) cardiac MRI (CMR) can predict AF. However, this relationship is not well described. Objective To delineate the association of cardiac fibrosis detected by LGE CMR with AF prevalence, AF recurrence after catheter ablation. Methods PubMed, Embase, Web of Science and Ovid MEDLINE were searched through November 2018, using the keywords: LGE AND Fibrosis AND CMR AND AF. Inclusion criteria: 1. LGE CMR of left atrial (LA LGE), ventricular wall (LV LGE) or right ventricular wall (RV LGE); 2. Studies reporting AF or recurrent arrhythmia after ablation; 3. Patient ≥18 years; and 4. ≥50 participants. Included studies were pooled in a random effects meta-analysis and reported as: mean difference (MD); unadjusted risk ratios (RR); adjusted hazard ratios (HR); and 95% confidence intervals (95% CI). Results After exclusions, we identified 9 studies (2,307 patients [65.9% males, 34.1% females]) conducted between 2003 and 2015 for LGE and AF. Fibrosis was present in 666 (35.1%) and detected by LV LGE in 7 (78%) and RV LGE in 2 (22%). The presence of AF was higher in patients positive for ventricular LGE than those negative, trending towards significance (RR: 1.51, 95% CI: 0.94–2.45, p=0.09). Pooled LV fibrosis associated with AF progression (RR [NPAF vs. PAF]: 2.2, 95% CI: 1.22–3.94, p=0.009). We identified 8 studies (2,041 patients [65.8% males, 34.2% females]) conducted between 2006 and 2016 reporting LGE and AF recurrence after catheter ablation, with fibrosis detected in 644 (31.6%) by LA LGE in 8 (88.9%, biased towards one centre). After 17.8±14.2 follow-up years, atrial fibrosis was significantly greater in recurrent AF than controls (MD: 4.97%, 95% CI: 1.23–8.7, p<0.01), and predicted 16% increased risk of AF recurrence (RR: 1.16, 95% CI: 1.07–1.26, p<0.05). Conclusion Myocardial fibrosis detected by LGE associates with prevalence and progress of AF and is predictive of AF recurrence post ablation. This further supports the proarrhythmic role of fibrosis and selection of patients for ablation therapy based on LGE.

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