Feasibility of catheter ablation in patients with persistent atrial fibrillation guided by fragmented late‐gadolinium enhancement areas

Abstract

Background A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE‐MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome. Methods A total of 31 consecutive persistent AF patients with FLAs were enrolled (FLA ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). A favorable response was defined as direct AF termination or AT conversion during RF applications at the FLA. The rhythm outcome was compared between the FLA ablation group and FLA burden‐matched pulmonary vein isolation (PVI) group. Results Favorable responses were found in 15 (48%) of 31 patients in the FLA group (AF termination in seven, AT conversion in eight patients), but not in the PVI group. AF recurrence at 12 months follow‐up was significantly less in the FLA ablation group than in the PVI group (4 [13%] vs. 12 [39%] of 31 patients, log‐rank p = .023). In patients with a favorable response, AT recurred in 1 (7%) of 15 patients, but AF did not. Conclusions FLA ablation could terminate AF or convert it to AT in half of the patients. No AF recurrence was documented in patients with a favorable response.

Late‐gadolinium enhancement properties associated with atrial fibrillation rotors in patients with persistent atrial fibrillation

“…To more sensitively detect weak LGE areas, we used the same protocol as in our previous study 9 . The 3D visualization method for the LGE was as follows.…”

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

“…To detect normal/mild LGE areas more sensitively, we used the same protocol as in our previous study. 12 The 3D visualization method for the LGE was as follows. First, the LA in the LGE‐MRI was semi‐manually segmented by contouring the borders between the endocardium and epicardium of the atrium, including the PVs, with reference to the CE‐MRA.…”

“…To detect normal/mild LGE areas more sensitively, we used the same protocol as in our previous study 12 . The 3D visualization method for the LGE was as follows.…”

Applications of multimodality imaging for left atrial catheter ablation

“…In a non-randomized study, AF organization and termination was demonstrated in a cohort of 31 persistent AF patients with a low rate of arrhythmia recurrence during follow-up in this group. 79 …”