Key result
Pulmonary vein ablation in paroxysmal AF is linked to a ~23% reduction in LA stasis.
Why the study?
Stroke events do not appear significantly reduced following successful pulmonary vein ablation, and this study investigated whether 4D-flow-derived left atrial stasis serves as a biomarker of left atrial recovery in AF.
Does pulmonary vein ablation reduce left atrial flow stasis as measured by 4D-flow MRI in patients with paroxysmal atrial fibrillation?
Observational (n=172)
Does pulmonary vein ablation reduce left atrial flow stasis as measured by 4D-flow MRI in patients with paroxysmal atrial fibrillation?
Absolute Event Rate: 36% vs 47%
p-value: p=0.002
4D-flow MRI demonstrates that pulmonary vein ablation significantly reduces left atrial flow stasis in patients with paroxysmal atrial fibrillation, providing a potential imaging biomarker for atrial recovery.
May indicate post-ablation atrial recovery on 4D-flow MRI in paroxysmal AF; leaves open effects on clinical outcomes.
Atrial fibrillation (AF) is associated with systemic thrombo-embolism and stroke events, which do not appear significantly reduced following successful pulmonary vein (PV) ablation. Prior studies supported that thrombus formation is associated with left atrial (LA) flow alterations, particularly flow stasis. Recently, time-resolved three-dimensional phase-contrast (4D-flow) showed the ability to quantify LA stasis. This study aims to demonstrate that LA stasis, derived from 4D-flow, is a useful biomarker of LA recovery in patients with AF. Our hypothesis is that LA recovery will be associated with a reduction in LA stasis. We recruited 148 subjects with paroxysmal AF (40 following 3–4 months PV ablation and 108 pre-PV ablation) and 24 controls (CTL). All subjects underwent a cardiac magnetic resonance imaging (MRI) exam, inclusive of 4D-flow. LA was isolated within the 4D-flow dataset to constrain stasis maps. Control mean LA stasis was lower than in the pre-ablation cohort (30 ± 12% vs. 47 ± 18%, p < 0.001). In addition, mean LA stasis was reduced in the post-ablation cohort compared with pre-ablation (36 ± 15% vs. 47 ± 18%, p = 0.002). This study demonstrated that 4D flow-derived LA stasis mapping is clinically relevant and revealed stasis changes in the LA body pre- and post-pulmonary vein ablation.
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Sheitt et al. (2021) conducted an observational in Paroxysmal Atrial Fibrillation (n=172). Pulmonary vein ablation vs. Pre-ablation paroxysmal AF patients and healthy controls was evaluated on Mean left atrial (LA) stasis derived from 4D-flow MRI (p=0.002). Pulmonary vein ablation in patients with paroxysmal atrial fibrillation was associated with a significant reduction in mean left atrial stasis compared to pre-ablation levels (36% vs 47%, p=0.002).
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