High pre-ablation myocardial extracellular volume fraction independently predicted atrial fibrillation recurrence after radiofrequency ablation (HR 1.84; 95% CI 1.24-2.33; p<0.01).
Cohort (n=399)
Does pre-ablation left ventricular extracellular volume fraction (ECV) derived from dual-energy CT predict atrial fibrillation recurrence after radiofrequency ablation in patients with non-paroxysmal AF?
Pre-ablation myocardial extracellular volume fraction derived from delayed-phase dual-energy CT independently predicts AF recurrence and improves risk stratification in patients with non-paroxysmal AF undergoing radiofrequency ablation.
Hazard Ratio: 1.84 (95% CI 1.24–2.33)
valor p: p=<0.01
Abstract Objectives To determine whether pre-ablation left ventricular extracellular volume fraction (ECV), derived from delayed-phase dual-energy cardiac computed tomography angiography (CTA), predicts atrial fibrillation (AF) recurrence after radiofrequency ablation in patients with non-paroxysmal AF. Methods In this retrospective cohort, 399 patients with non-paroxysmal AF undergoing radiofrequency ablation were included. All patients underwent preprocedural cardiac CTA with delayed-phase imaging acquired 5 minutes after contrast administration to quantify left ventricular ECV. To identify independent predictors of AF recurrence, patients were stratified by an optimal ROC-derived cutoff and analyzed using univariate and multivariate Cox proportional hazards models. Model performance was assessed using the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI). Results During 10.1 months of follow-up (interquartile range, 8.1-13.6), 91 patients (22.8%) experienced AF recurrence after post-ablation. Recurrence was significantly associated with higher ECV values (37.6% ± 5.05% vs. 32.6% ± 2.05%; p 0.01). The optimal ECV cutoff of 34.69% demonstrated an area under the curve (AUC) of 0.85 (95%CI: 0.79-0.90). Multivariate Cox regression identified high ECV (HR = 1.84; 95%CI: 1.24-2.33; p 0.01) as independent predictors of AF recurrence. Additionally, integrating ECV with traditional clinical risk factors significantly enhanced predictive performance, achieving a C-index of 0.82 (95% CI: 0.74–0.86), an IDI of 0.66 (95%CI: 0.41–0.91), and an NRI of 0.55 (95%CI: 0.26–0.61). Conclusions In non-paroxysmal AF patients, myocardial ECV derived from delayed-phase CT is an independent predictor of AF recurrence. Advances in Knowledge This study provides evidence that DECT-derived ECV, a surrogate marker of diffuse myocardial fibrosis, can stratify recurrence risk in non-paroxysmal AF patients.
Lin et al. (Thu,) conducted a cohort in Non-paroxysmal atrial fibrillation (n=399). High pre-ablation left ventricular extracellular volume fraction (ECV) vs. Low ECV was evaluated on Atrial fibrillation recurrence (HR 1.84, 95% CI 1.24-2.33, p=<0.01). High pre-ablation myocardial extracellular volume fraction independently predicted atrial fibrillation recurrence after radiofrequency ablation (HR 1.84; 95% CI 1.24-2.33; p<0.01).