Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
July 10, 2026Journal of Cardiovascular Electrophysiology

Atrial Fibrosis Imaging: Correlation of Late Gadolinium Enhancement Magnetic Resonance Imaging With High‐Definition Voltage Electroanatomical Mapping Across Different Thresholds

View Full Paper
Ask AI
Bookmark
Share

Key result

LGE-CMR correlates poorly with EAM for quantifying atrial fibrosis despite ~97% dichotomous agreement.

  • Agreement 0.97
  • 95% CI 0.92-1.00
  • P<0.001
  • n=60

Why the study?

Atrial fibrosis contributes to arrhythmia recurrences and thromboembolism in AF, but evidence regarding CMRi as a noninvasive tool for its assessment remains conflicting.

Does CMR-derived atrial fibrosis correlate with EAM-derived low-voltage substrates in ablation-naïve patients with atrial fibrillation?

Population

Sixty ablation-naïve patients with AF scheduled for first-time catheter ablation

Comparison

LGE-CMRi fibrosis thresholds vs high-density EAM low-voltage substrate thresholds

Design

Observational cohort study

Authors

TETheodoros EfremidisENE NyktariOKOurania Kariki

Discussion

Loading...

Member takes

Overview

May support CMRi fibrosis assessment pre-AF ablation; leaves open its role in risk stratification pending validation.

Key Points

  • This research investigates the correlation between late gadolinium enhancement magnetic resonance imaging and electroanatomical mapping in assessing atrial fibrosis in patients with atrial fibrillation.
  • Sixty ablation-naïve patients with atrial fibrillation underwent cardiac magnetic resonance imaging before catheter ablation.
  • A high-resolution 3D late gadolinium enhancement sequence was utilized for fibrosis quantification at multiple intensity thresholds.
  • Electroanatomical mapping determined low-voltage substrates across different voltage thresholds.
  • Quantitative correlation between CMR and EAM-derived fibrosis was negligible to weak across threshold combinations.
  • Agreement in diagnosing fibrosis presence was highest between EAM 0.5 mV and CMR IIR 0.97, achieving 97% agreement.
  • Standardized protocols for CMR are essential for non-invasive assessment of atrial fibrosis.

Study Design

Type

Observational (n=60)

Structured PICO

Does CMR-derived atrial fibrosis correlate with EAM-derived low-voltage substrates in ablation-naïve patients with atrial fibrillation?

P
Population
60 ablation-naïve patients with atrial fibrillation (78% men, 73% HFrEF) scheduled for first-time catheter ablation.
E
Exposure
Cardiac magnetic resonance imaging (CMRi) with 3D late gadolinium enhancement (LGE) to quantify left atrial fibrosis at four image intensity ratio thresholds (0.97, 1.2, 1.32, and 1.61).
C
Comparator
High-density electroanatomical mapping (EAM) to quantify low-voltage substrates at three bipolar voltage thresholds (0.5, 0.25, and 0.1 mV).
O
Outcome
Quantitative correlation and dichotomous agreement between CMR-derived fibrosis and EAM-derived low-voltage substrates.surrogate

Main Result

Effect estimate: Agreement 0.97 (95% CI 0.92-1.00)

p-value: p=< 0.001

CMR and EAM measures of atrial fibrosis show poor quantitative correlation in ablation-naïve AF patients, indicating that current CMR protocols may not reliably substitute for invasive mapping without further standardization.

Limitations

  • Lack of standardized, validated, and reproducible CMR protocols for native atrial fibrosis assessment

Cite This Study

Efremidis et al. (2026) conducted an observational in Atrial fibrillation (n=60). Late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMRi) vs. High-density electroanatomical mapping (EAM) was evaluated on Quantitative correlation and dichotomous agreement between CMR- and EAM-derived fibrosis (Agreement 0.97, 95% CI 0.92-1.00, p=< 0.001). Late gadolinium enhancement CMRi showed poor quantitative correlation with electroanatomical mapping for atrial fibrosis, though dichotomous agreement was high at sensitive thresholds (0.97; P<0.001).

synapsesocial.com/papers/6a508da76eeac72a437a1092https://doi.org/10.1111/jce.70447
View Full Paper
Ask AI
Bookmark
Share

Also Consider

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

  1. 1Correlation between late gadolinium enhancement mri and high-definition electroanatomical voltage mapping for atrial fibrosis assessment across multiple thresholds2026
  2. 2The correlation between left atrium voltage mapping and 3D late gadolinium enhancement cardiac magnetic resonance imaging findings in patients with known atrial fibrillation2024
  3. 3Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility2016 · 155 citations
  4. 4Assessment of Left Atrial Fibrosis With Cardiac <scp>MRI</scp>2025 · 1 citations
  5. 5Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging2024 · 5 citations