Impact of left atrial volume, sphericity, and fibrosis on the outcome of catheter ablation for atrial fibrillation

Uijl, Dennis W. den; Cabanelas, Nuno; Benito, Eva; Figueras, R.; Alarcón, Francisco; Borràs, Roger; Prat, Susanna Soler; Guasch, Eduard; Perea, Rosario J.; Sitges, Marta; Brugada, Josép; Berruezo, Antonio; Mont, Lluı́s

doi:10.1111/jce.13482

Cited by 33 publications

(39 citation statements)

References 24 publications

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“…In this combined assessment, the associations were replicated, but they were not shown to be independent. To some extent, the findings here are in concordance with the recent findings of den Uijl et al: on assessment of a more limited set of CMR parameters (LA fibrosis, LA size, and LA sphericity) with shorter follow‐up, they found that only one parameter was associated with recurrence on stepwise multivariable analysis. However, for their study, the predictive variable was LA size and the methodological differences are important.…”

Section: Discussionsupporting

confidence: 92%

“…LAEF, LVEF, and indexed LA volume have been shown to be associated with outcome in other studies . In this combined assessment, the associations were replicated, but they were not shown to be independent.…”

Section: Discussionmentioning

confidence: 51%

“…An independently derived quantification method, based on an image intensity ratio, was developed for this study. LA size. CMR imaging may be used to assess atrial volume, calculated from multislice cine imaging or segmentation of a 3D volumetric dataset, and has been shown to be associated with long‐term AF recurrence LA function.…”

Section: Introductionmentioning

confidence: 99%

“…LA size. CMR imaging may be used to assess atrial volume, calculated from multislice cine imaging or segmentation of a 3D volumetric dataset, and has been shown to be associated with long‐term AF recurrence …”

Section: Introductionmentioning

confidence: 99%

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A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

Chubb

Karim

Mukherjee

et al. 2019

Cardiovasc electrophysiol

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Introduction Multiple cardiac magnetic resonance (CMR)‐derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long‐term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), left ventricular ejection fraction (LVEF), LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long‐term single‐center study. Methods and Results Eighty‐nine patients (53% paroxysmal AF, 73% male) underwent comprehensive CMR study before first‐time AF ablation (median follow‐up 726 days [IQR: 418‐1010 days]). The 3D late gadolinium‐enhanced acquisition (1.5T, 1.3 × 1.3 × 2 mm) was quantified for fibrosis; LA volume and sphericity were assessed on manual segmentation at atrial diastole; LAEF and LVEF were quantified on multislice cine imaging. AF recurred in 43 patients (48%) overall (31 at 1 year). In the recurrence group, LA fibrosis was higher (42% vs 29%; hazard ratio [HR]: 1.032; P = .002), left atrial ejection fraction (LAEF) lower (25% vs 34%; HR: 0.063; P = .016) and LVEF lower (57% vs 63%; HR: 0.011; P = .008). LA volume (135 vs 124 mL) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (Model 1), additionally AF type (Model 2) and combined (Model 3). In Models 1 and 2, LA fibrosis, LAEF, and LVEF were independently associated with outcome, but only LA fibrosis was independent in Model 3 (HR: 1.021; P = .022). Conclusions LAEF, LVEF, and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

Chubb

Karim

Mukherjee

et al. 2019

Cardiovasc electrophysiol

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“…Correlation studies show a low‐to‐moderate, yet statistically significant, association between CMR‐detected native fibrosis and bipolar voltage during sinus rhythm 15,18 . The preprocedural fibrosis burden predicts AF recurrences after PVI, 19,20 but whether targeting fibrotic patches improves efficacy is still under study in randomized clinical trials (DECAAF [NCT02529319], ALICIA [NCT02698631]). Reproducibility has remained controversial, although, standardized methods to quantify native atrial fibrosis have been published 15 …”

Section: Discussionmentioning

confidence: 99%

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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Introduction Ablation with second‐generation cryoballoon technology evolves as an effective and safe alternative to radiofrequency for atrial fibrillation ablation procedures. Nevertheless, the optimal freezing strategy remains unknown. Our objective was to identify the procedural cryoablation parameters predicting successful peri‐pulmonary vein (PV) lesions by directly analyzing Postablation gaps in late‐gadolinium‐enhanced cardiac magnetic resonance (LGE‐CMR). Methods and Results Forty‐nine consecutive patients (196 PVs) undergoing ablation with second‐generation cryoballoon at our center were included. The number and duration of cryoballoon application to achieve PV isolation were left to operator discretion. Gap number and length were quantified in all patients with a LGE‐CMR performed 3 months postablation. Application time (420 ± 217 seconds), number of applications (2.1 ± 1.2), application time after electrical isolation (311 ± 194 seconds) and minimum temperature (−45.8 ± 6.5°C) were similar in the 4 PVs. Gaps were observed in 148 PVs (76%), averaging 1.3 ± 1 gaps per vein. Gaps were longer and more frequent in the right PVs (91% vs 59% in left PVs, P < .001). Neither the number, total duration of applications, nor postisolation application time predicted relative length or number of gaps. Conclusions After successful PV isolation was achieved in patients undergoing cryoablation, increasing the number of applications, the total application time or application time postisolation did not result in a reduction in the number or the relative length of gaps.

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Combined Atrial Volume is Associated with Significant Atrial Arrhythmias in Total Cavopulmonary Connection Fontan Patients

Kamp,

Kiper,

Russell

et al. 2023

Pediatr Cardiol

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Impact of left atrial volume, sphericity, and fibrosis on the outcome of catheter ablation for atrial fibrillation

Abstract: LA volume, sphericity, and fibrosis were closely related; however, LA volume was the strongest predictor of AF recurrence after catheter ablation.

Cited by 33 publications

References 24 publications

A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Combined Atrial Volume is Associated with Significant Atrial Arrhythmias in Total Cavopulmonary Connection Fontan Patients

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