Key result
Pre-procedural antero-posterior left atrial diameter independently predicted AF recurrence after ablation (HR 1.079; 95% CI 1.013-1.148; p=0.018), whereas atrial fibrosis burden did not.
Why the study?
Does pre-procedural atrial fibrosis quantification by MRI predict AF recurrence after ablation in patients without long-standing persistent AF?
Cohort (n=94)
Does pre-procedural atrial fibrosis quantification by MRI predict AF recurrence after ablation in patients without long-standing persistent AF?
Effect estimate: HR 1.079 (95% CI 1.013-1.148)
p-value: p=0.018
In a population with low-grade atrial fibrosis undergoing AF ablation, traditional LA diameter independently predicted recurrence, whereas MRI-derived fibrosis quantification did not add predictive value.
LA diameter may aid post-ablation recurrence risk assessment; leaves open incremental value of MRI fibrosis quantification in low-grade fibrosis cohorts.
Introduction: Pre-procedural patient selection refinement can possibly improve results of AF ablation. Recent inputs from cardiac magnetic resonance imaging (MRI) with atrial fibrosis quantification are being evaluated in this setting, in addition to traditional prognostic factors. The aim of this analysis is to evaluate which factors add prognostic information in a selected population undergoing AF ablation. Methods: Patients referred for AF ablation according to conventional indications, who were submitted to 3-Tesla cardiac MRI with late-gadolinium enhancement before the procedure were selected and prospectively followed. Long-standing persistent AF and antero-posterior (AP) left atrium (LA) diameter > 55 mm were exclusion criteria. Baseline clinical and echocardiographic data and LA volume and sphericity (derived from MRI) were registered. Fibrosis quantification was obtained using a dedicated offline image processing software. These data were evaluated in order to find predictors of AF recurrence. Results: Ninety four patients were included. Baseline characteristics are shown in the table. Recurrence incidence was 44.7%. LA diameter (p = 0.04, HR 1.064, IC95%: 1.003–1.128), LA volumen (p = 0.027, HR 1.013, IC95%: 1.001–1.024) and LA sphericity (p = 0.042, HR 1.112, IC95%: 1.004–1.231) were the parameters that predicted recurrences, but atrial fibrosis burden did not. On multivariate analysis, only LA diameter behaved as an independent predictor of recurrence (p = 0.018, HR 1.079, IC95%: 1.013–1.148). A LA diameter above 41.5 mm was associated with a recurrence relative risk increase of 2.61. Conclusions: AP LA diameter obtained in pre-procedural assessment, as well as left atrial volume and sphericity predicted AF recurrences after ablation. This population was globally homogeneous with low grade of atrial fibrosis, and, in this setting, fibrosis quantification had low predictive value.
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Cabanelas et al. (2016) conducted a cohort in Atrial fibrillation (n=94). Pre-procedural 3-Tesla cardiac MRI with late-gadolinium enhancement was evaluated on Atrial fibrillation recurrence (HR 1.079, 95% CI 1.013-1.148, p=0.018). Pre-procedural antero-posterior left atrial diameter independently predicted AF recurrence after ablation (HR 1.079; 95% CI 1.013-1.148; p=0.018), whereas atrial fibrosis burden did not.
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