Key result
Enhanced LA sphericity on LGE-CMR links to ~30% higher atypical flutter recurrence after AF ablation.
Why the study?
Atypical AFL recurrence after AF catheter ablation often requires redo ablation with limited success, and identifying high-risk patients could guide patient selection and personalized ablation approaches.
Do LGE-CMR markers of advanced atrial cardiomyopathy predict atypical atrial flutter recurrence in patients undergoing atrial fibrillation ablation?
Cohort (n=166)
Do LGE-CMR markers of advanced atrial cardiomyopathy predict atypical atrial flutter recurrence in patients undergoing atrial fibrillation ablation?
Effect estimate: OR 1.3 (95% CI 1.1-1.6)
Advanced atrial cardiomyopathy assessed by LGE-CMR is independently associated with atypical atrial flutter recurrence after AF ablation, which may aid in patient selection and personalized ablation strategies.
LGE-CMR atrial cardiomyopathy markers were associated with post-ablation atypical AFL; may aid stratification but leaves open prospective validation of imaging-guided strategies.
AIMS: Recurrence of arrhythmia after catheter ablation of atrial fibrillation (AF) in the form of atypical atrial flutter (AFL) is common among a significant number of patients and often requires redo ablation with limited success rates. Identifying patients at high risk of AFL after AF ablation could aid in patient selection and personalized ablation approach. The study aims to assess the relationship between pre-existing atrial cardiomyopathy and the occurrence of AFL following AF ablation. METHODS AND RESULTS: We analysed a cohort of 1007 consecutive AF patients who underwent catheter ablation and were included in a prospective registry. Patients who did not have baseline cardiac magnetic resonance imaging and late gadolinium enhancement (LGE-CMR) or did not experience any recurrences were excluded. A total of 166 patients were included gathering 56 patients who underwent re-ablation due to AFL recurrences and 110 patients who underwent re-ablation due to AF recurrences (P = 0.11). A multiparametric assessment of atrial cardiomyopathy was based on basal LGE-CMR, including left atrial (LA) volume, LA sphericity, and global and segmental LA fibrosis using semiautomated post-processing software. Out of the initial cohort of 1007 patients, AFL and AF occurred in 56 and 110 patients, respectively. An age higher than 65 [odds ratio (OR) = 5.6, 95% confidence interval (CI): 2.2-14.4], the number of previous ablations (OR = 3.0, 95% CI: 1.2-7.8), and the management of ablation lines in the index procedure (OR = 2.5, 95% CI: 1.0-6.3) were independently associated with AFL occurrence. Furthermore, several characteristics assessed by LGE-CMR were identified as independent predictors of AFL recurrence after the index ablation for AF, such as enhanced LA sphericity (OR = 1.3, 95% CI: 1.1-1.6), LA global fibrosis (OR = 1.03, 95% CI: 1.01-1.07), and increased fibrosis in the lateral wall (OR = 1.03, 95% CI: 1.01-1.04). CONCLUSION: Advanced atrial cardiomyopathy assessed by LGE-CMR, such as increased LA sphericity, global LA fibrosis, and fibrosis in the lateral wall, is independently associated with arrhythmia recurrence in the form of AFL following AF ablation.
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Ferró et al. (2023) conducted a cohort in Atrial fibrillation (n=166). LGE-CMR assessment of atrial cardiomyopathy was evaluated on Atypical atrial flutter recurrence (OR 1.3, 95% CI 1.1-1.6). Advanced atrial cardiomyopathy assessed by LGE-CMR, including enhanced LA sphericity (OR 1.3; 95% CI 1.1-1.6), was independently associated with atypical atrial flutter recurrence after AF ablation.
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