The impact of the atrial wall thickness in normal/mild late‐gadolinium enhancement areas on atrial fibrillation rotors in persistent atrial fibrillation patients. Issue 2 (13th January 2022)

• Record Type: Journal Article
• Authors: Nakamura, Toshihiro; Kiuchi, Kunihiko; Fukuzawa, Koji; Takami, Mitsuru; Watanabe, Yoshiaki; Izawa, Yu; Takemoto, Makoto; Sakai, Jun; Yatomi, Atsusuke; Sonoda, Yusuke; Takahara, Hiroyuki; Nakasone, Kazutaka; Yamamoto, Kyoko; Suzuki, Yuya; Tani, Ken‐ichi; Negi, Noriyuki; Kono, Atsushi; Ashihara, Takashi; Hirata, Ken‐ichi
• Is Part Of: Journal of arrhythmia. Volume 38:Issue 2(2022)
• Page Start: 221
• Page End: 231
• Publication Date: 2022-01-13
• Subjects: atrial fibrillation -- atrial wall thickness -- fibrosis -- late‐gadolinium enhancement magnetic resonance imaging -- rotor; Arrhythmia -- Periodicals; Cardiac pacing -- Periodicals; Arrhythmias, Cardiac; Arrhythmia; Cardiac pacing; Periodicals; Electronic journals; Periodicals; 616.128
• DOI: 10.1002/joa3.12676
• Languages: English
• ISSNs: 1880-4276

Abstract

Abstract: Background: Some of atrial fibrillation (AF) drivers are found in normal/mild late‐gadolinium enhancement (LGE) areas, as well as moderate ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. Objective: The purpose of this study was to evaluate the impact of the AWT in normal/mild LGE areas on AF drivers. Methods: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non‐passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real‐time phase mapping (ExTRa Mapping), mild LGE areas were defined as areas with a volume ratio of the enhancement voxel of 0% to <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE‐MRI. Results: NPAs were found in 20 (18.0%) of 131 normal/mild LGE areas where AWT was significantly thicker than that in the passively activated areas (PAs) (2.5 ± 0.3 vs. 2.2 ± 0.3 mm, p < .001). However, NPAs were found in 41 (26.3%) of 156 moderate LGE areas where AWT was thinner than that of PAs (2.1 ± 0.2 mm vs. 2.23 ± 0.3 mm, p = .02). An ROC curve analysis yielded an optimal cutoff value of 2.2 mm for predicting the presence of an NPA in normal/mild LGE areas. Conclusion: The location of AF drivers in normal/mild LGE areas might be more accurately identified by evaluating AWT. Abstract : This study evaluated that the impact of the AWT in normal/mild LGE areas on AF rotors. In this study, NPAs were found in 20 (15.3%) of 131 normal/mild LGE areas where the AWT was significantly thicker in the NPAs than PAs. However, NPAs were found in 41 (26.3%) of 156 moderate LGE areas where the AWT was thinner than that of the PAs. AF, atrial fibrillation; AWT, atrial wall thickness; LGE, late gadolinium enhancement; NPA, non‐passively activated area; PA, passively activated area.