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June 14, 2026European Heart Journal - Imaging Methods and PracticeOpen Access

High-resolution 3D LA-LGE detects ~3-fold higher left atrial enhancement in persistent versus paroxysmal AF.

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Why the study?

Conventional LGE sequences lack sufficient spatial resolution to accurately depict the thin atrial wall, and reference data in healthy cohorts are scarce.

Does high-resolution isotropic 3D LGE imaging accurately quantify left atrial fibrosis and post-ablation scarring compared to electroanatomical mapping in AF patients?

Population

40 ablation-naïve AF patients and 20 healthy controls

Comparison

Isotropic 3D LGE imaging across AF subtypes, healthy controls, and post-ablation

Design

Prospective study

Follow-up

Six months post ablation

Key result

High-resolution isotropic 3D LA-LGE imaging detected higher total left atrial enhancement in persistent AF (3.65%) compared to paroxysmal AF (1.16%, P=0.044) and healthy controls (1.25%, P=0.041).

Authors

MFMaximilian FenskiRHRichard HicksteinLKLeo Dyke Krüger

Discussion

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Overview

High-resolution 3D LGE Dixon enables LA fibrosis reference values in healthy subjects; leaves open its prognostic utility in AF cohorts.

Key Points

  • This study aims to assess the effectiveness of high-resolution 3D LGE imaging in quantifying left atrial fibrosis in atrial fibrillation patients and healthy controls.
  • Prospective study including 40 ablation-naïve AF patients and 20 healthy controls.
  • Patients underwent isotropic 3D whole-heart LGE imaging with a resolution of 1.3 mm³.
  • Fibrosis detection was validated against electroanatomical mapping and follow-up imaging at six months post ablation.
  • Persistent AF patients exhibited higher total LA enhancement than paroxysmal AF (3.65% vs. 1.16%, P=0.044) and controls (1.25%, P=0.041).
  • Fibrosis increased significantly in patients after follow-up from 1.68% to 6.30% (P<0.001), indicating ablation-induced scarring.
  • Intra-reader correlation for LA-LGE showed excellent reliability (ICC 0.99, 95% CI 0.95–0.99).

Study Design

Type

Observational (n=60)

Structured PICO

Does high-resolution isotropic 3D LGE imaging accurately quantify left atrial fibrosis and post-ablation scarring compared to electroanatomical mapping in AF patients?

P
Population
60 participants, comprising 40 ablation-naïve AF patients and 20 healthy controls, evaluated with high-resolution 3D LGE imaging and followed for 6 months post-ablation.
E
Exposure
High-resolution isotropic (1.3 mm3) 3D whole-heart late gadolinium enhancement (LGE) Dixon sequence imaging.
C
Comparator
Healthy controls (for baseline comparison) and pre-procedural electroanatomical mapping (EAM).
O
Outcome
Total left atrial (LA) enhancement (fibrosis) and post-ablation scarring.surrogate

Main Result

Absolute Event Rate: 3.65% vs 1.16%

p-value: p=0.044

High-resolution 3D LA-LGE can detect ablation-induced scarring and differences between AF stages, but correlates poorly with bipolar voltage mapping, suggesting they provide complementary information.

Limitations

  • Correlation with bipolar voltage mapping remains limited

Cite This Study

Fenski et al. (2026) conducted an observational in Atrial fibrillation (n=60). High-resolution isotropic 3D LGE imaging vs. Paroxysmal AF and healthy controls was evaluated on Total LA enhancement at baseline (p=0.044). High-resolution isotropic 3D LA-LGE imaging detected higher total left atrial enhancement in persistent AF (3.65%) compared to paroxysmal AF (1.16%, P=0.044) and healthy controls (1.25%, P=0.041).

synapsesocial.com/papers/6a2e45d5b1cc60ccdea8ac23https://doi.org/10.1093/ehjimp/qyag100
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility2016 · 155 citations
  2. 2Assessment of Left Atrial Fibrosis With Cardiac <scp>MRI</scp>2025 · 1 citations
  3. 3The correlation between left atrium voltage mapping and 3D late gadolinium enhancement cardiac magnetic resonance imaging findings in patients with known atrial fibrillation2024
  4. 4Accuracy of left atrial fibrosis detection with cardiac magnetic resonance: correlation of late gadolinium enhancement with endocardial voltage and conduction velocity2020 · 92 citations
  5. 5Reproducibility and accuracy of late gadolinium enhancement cardiac magnetic resonance measurements for the detection of left atrial fibrosis in patients undergoing atrial fibrillation ablation procedures2018 · 42 citations