What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=467). Intervention: Computed tomography-quantified extracellular volume (CT-ECV). Primary outcome: Atrial fibrillation recurrence within 400 days after catheter ablation (p=0.727).

October 9, 2025Heart Rhythm O21 citationsOpen Access

The usefulness of catheter ablation even in patients with myocardial impairment: Myocardial extracellular volume assessed by preablation planning computed tomography cannot predict atrial fibrillation recurrence

YTYuichiro TsurutaKumamoto University HKHisanori KanazawaKumamoto University YTYuta TsurusakiKumamoto University

Key Result

Computed tomography-quantified extracellular volume (CT-ECV) was not significantly associated with atrial fibrillation recurrence within 400 days after the first catheter ablation (P=0.727).

Study Design

Type

Cohort (n=467)

Multicenter

Structured PICO

Does myocardial extracellular volume assessed by computed tomography (CT-ECV) predict atrial fibrillation recurrence after first catheter ablation?

Population

467 consecutive patients undergoing their first catheter ablation for atrial fibrillation between January 2021 and June 2023

Intervention

Catheter ablation for atrial fibrillation with pre-ablation contrast-enhanced computed tomography to assess myocardial extracellular volume (CT-ECV)

Outcome

Atrial fibrillation recurrence within 400 days after catheter ablationhard clinical

Pre-ablation CT-ECV does not predict AF recurrence within 400 days, suggesting catheter ablation remains beneficial for preventing AF and improving cardiac function regardless of ventricular myocardial damage severity.

Main Result

p-value: p=0.727

Abstract

Background: Increased left ventricular extracellular volume (ECV) measured by cardiac magnetic resonance imaging is associated with myocardial damage and has been considered to predict atrial fibrillation (AF) recurrence after catheter ablation (CA). However, recent reports suggest that AF recurrence is infrequent even with high ECV owing to advancing ablation technology. Objective: This study aimed to evaluate the relationship between ECV quantified by computed tomography (CT-ECV), commonly performed before CA, and AF recurrence. Methods: Consecutive 467 patients undergoing their first CA for AF at our hospital between January 2021 and June 2023 received pre-CA contrast-enhanced CT. The relationship between CT-ECV and AF recurrence within 400 days after CA was examined. Results: = .727). Brain natriuretic peptide level, left ventricular ejection fraction, and left atrial volume index significantly improved even in the high CT-ECV group without AF recurrence. Conclusion: CT-ECV was not significantly associated with AF recurrence within 400 days after the first CA. Regardless of the severity of ventricular myocardial damage, CA for AF is beneficial for preventing AF and improving cardiac function.

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