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Atrial Fibrosis by Late Gadolinium Enhancement Magnetic Resonance Imaging and Catheter Ablation of Atrial Fibrillation: 5‐Year Follow‐Up Data

Authors :
Arif Elvan
Gagandeep Kaur
Promporn Suksaranjit
Eugene G. Kholmovski
Pim Gal
Junjie Ma
Mihail G. Chelu
Michelle A. Silver
Nassir F. Marrouche
Kara A. Johnson
Jordan B. King
Brent D. Wilson
Frederick T. Han
Mossab Aljuaid
Qussay Marashly
Source :
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Publication Year :
2018
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2018.

Abstract

Background Late gadolinium enhancement magnetic resonance imaging is an effective tool for assessment of atrial fibrosis. The degree of left atrial fibrosis is a good predictor of atrial fibrillation ( AF ) ablation success at 1 year, but the association between left atrial fibrosis and long‐term ablation success has not been studied. Methods and Results Late gadolinium enhancement magnetic resonance images of sufficient quality to quantify atrial fibrosis were obtained before the first AF ablation in 308 consecutive patients. Left atrial fibrosis was classified in 4 Utah stages (I, 0–10%; II , 10–20%; III , 20–30%; and IV , >30%). Patients were followed up for up to 5 years until the time of first arrhythmia recurrence or second ablation. A total of 308 patients were included; the mean age was 64.5±12.1 years, and 63.4% were men. During follow‐up, 157 patients experienced an arrhythmia recurrence and 106 patients underwent a repeated ablation. A graded effect was observed in which patients with more advanced atrial fibrosis were more likely to experience recurrent AF (hazard ratio for stage IV versus stage I, 2.73; 95% confidence interval, 1.57–4.75) and undergo a repeated ablation (proportional odds ratio for stage IV versus stage I, 5.19; 95% confidence interval, 2.12–12.69). Conclusions The degree of left atrial fibrosis predicts the success of AF ablation at up to 5 years follow‐up. In patients with advanced atrial fibrosis, AF ablation is associated with a high procedural failure rate.

Details

ISSN :
20479980
Volume :
7
Database :
OpenAIRE
Journal :
Journal of the American Heart Association
Accession number :
edsair.doi.dedup.....0f11a328f0097d33ca78155131c3f97a
Full Text :
https://doi.org/10.1161/jaha.117.006313