Left atrial functional and structural changes associated with ablation of atrial fibrillation - Cardiac magnetic resonance study. (15th April 2020)

• Record Type: Journal Article
• Authors: Csécs, Ibolya; Yamaguchi, Takanori; Kheirkhahan, Mobin; Czimbalmos, Csilla; Fochler, Franziska; Kholmovski, Eugene G.; Morris, Alan K.; Kaur, Gagandeep; Vago, Hajnalka; Merkely, Bela; Chelu, Mihail G.; Marrouche, Nassir F.; Wilson, Brent D.
• Is Part Of: International journal of cardiology. Volume 305(2020)
• Page Start: 154
• Page End: 160
• Publication Date: 2020-04-15
• Subjects: AUC area under the curve -- AF atrial fibrillation -- bSSFP balanced Steady-State Free Precession -- CMRi Cardiac Magnetic Resonance Imaging -- EF ejection fraction -- LA left atrium -- LAV left atrial volume -- LGE late gadolinium enhancement -- NOAC Novel Oral Anticoagulants -- PFA periprocedural fluid administration -- PFB periprocedural fluid balance -- PLAS peak longitudinal atrial strain -- PVI pulmonary vein isolation; Atrial fibrillation -- Cardiac magnetic resonance -- Recurrence -- Ablation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.12.010
• Languages: English
• ISSNs: 0167-5273

Abstract

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. Highlights: This longitudinal CMRi study reports left atrial (LA) function and structure pre-ablation, acutely (< 24-h) and at follow-up Lower LA strain (measured in sinus rhythm) correlated with higher fibrosis Besides baseline LA function and fibrosis, acute functional impairment also associated with AF recurrence Acute functional impairment was more severe in patients with high baseline LA fibrosis Poor functional recovery was detected in patients with poor baseline function regardless of the amount of ablation scar