Key result
Post-ablation AF linked to ~2.4-fold higher left atrial fibroblast activity vs controls.
Why the study?
Conventional CMR cannot capture biological activity of inflammation or fibrosis essential for understanding arrhythmic substrate progression after AF catheter ablation.
Does [68Ga]Ga-FAPI-04 PET/CMR imaging identify ongoing atrial fibroblast activation and correlate with structural remodeling and recurrence risk in patients with atrial fibrillation post-catheter ablation?
Observational (n=40)
No
Does [68Ga]Ga-FAPI-04 PET/CMR imaging identify ongoing atrial fibroblast activation and correlate with structural remodeling and recurrence risk in patients with atrial fibrillation post-catheter ablation?
[68Ga]Ga-FAPI-04 PET/CMR demonstrates that ongoing molecular fibroblast activation persists in the left atrium after AF ablation and strongly correlates with mechanical dysfunction, structural remodeling, and clinical arrhythmia recurrence.
Answers are grounded in this paper and cite their sources.
Post-ablation AF shows persistent fibroblast activation; hypothesis-generating for FAPI-PET in guiding future risk stratification.
Conventional CMR alone cannot capture the biological activity of inflammation or fibrosis, which may be essential for understanding arrhythmic substrate progression. We aimed to utilize [ 68 Ga]Ga-FAPI-04 PET/CMR imaging to explore the structural and functional remodeling characteristics in patients with atrial fibrillation (AF) who had undergone catheter ablation and reached a stable post-procedural state. The analysis focused on describing the potential relationships among atrial fibroblast activation, atrial structure and function, and epicardial adipose tissue (EAT) characteristics. During the stable post-ablation phase, 74% (23/31) AF patients exhibited increased [ 68 Ga]Ga-FAPI-04 uptake in LA, predominantly located in the posterior wall and around the pulmonary veins. Compared with controls, AF patients showed significantly higher LA FAPI burden accompanied by global impairment of atrial and ventricular mechanics. Patients with persistent AF demonstrated greater LA fibroblast activation burden, enlarged LA volume, and more severe reductions in LA ejection fraction (LAEF) and strains. Recurrence was characterized by a mechanical atrial failure phenotype with markedly increased LA surface volume. LA FAPI burden correlated positively with percent of late gadolinium enhancement and atrial and ventricular volumes, and inversely with LAEF and atrial and ventricular strain parameters, indicating a close association between persistent fibroblast activation and atrioventricular mechanical decompensation. In addition, EAT FAPI activity showed concordant associations with LA structural and functional remodeling, and LA FAPI burden was positively related to stroke risk scores. [ 68 Ga]Ga-FAPI-04 PET/CMR provides unique molecular insights into atrial fibroblast activation in post-ablation AF patients. The integration of molecular and functional imaging provides complementary insights that may help generate hypotheses for future individualized management.
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尹峰 et al. (2026) conducted an observational in Atrial Fibrillation (n=40). Atrial fibrillation post-catheter ablation vs. Healthy controls without structural heart disease was evaluated on Left atrial surface fibroblast activity (LA SFA) (p=<0.001). Post-ablation atrial fibrillation patients exhibited higher left atrial surface fibroblast activity compared to controls, indicating persistent fibrotic remodeling.
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