Advanced left atrial fibrosis (Utah stage IV vs I) was associated with a higher risk of recurrent atrial fibrillation up to 5 years after ablation (HR 2.73; 95% CI 1.57-4.75).
Cohort (n=308)
Does the degree of left atrial fibrosis assessed by LGE-MRI predict long-term arrhythmia recurrence after AF ablation?
The degree of left atrial fibrosis assessed by LGE-MRI strongly predicts long-term procedural success and arrhythmia recurrence up to 5 years after AF ablation.
Effect estimate: HR 2.73 (95% CI 1.57-4.75)
Background Late gadolinium enhancement magnetic resonance imaging is an effective tool for assessment of atrial fibrosis. The degree of left atrial fibrosis is a good predictor of atrial fibrillation ( AF ) ablation success at 1 year, but the association between left atrial fibrosis and long‐term ablation success has not been studied. Methods and Results Late gadolinium enhancement magnetic resonance images of sufficient quality to quantify atrial fibrosis were obtained before the first AF ablation in 308 consecutive patients. Left atrial fibrosis was classified in 4 Utah stages (I, 0–10%; II , 10–20%; III , 20–30%; and IV , >30%). Patients were followed up for up to 5 years until the time of first arrhythmia recurrence or second ablation. A total of 308 patients were included; the mean age was 64.5±12.1 years, and 63.4% were men. During follow‐up, 157 patients experienced an arrhythmia recurrence and 106 patients underwent a repeated ablation. A graded effect was observed in which patients with more advanced atrial fibrosis were more likely to experience recurrent AF (hazard ratio for stage IV versus stage I, 2.73; 95% confidence interval, 1.57–4.75) and undergo a repeated ablation (proportional odds ratio for stage IV versus stage I, 5.19; 95% confidence interval, 2.12–12.69). Conclusions The degree of left atrial fibrosis predicts the success of AF ablation at up to 5 years follow‐up. In patients with advanced atrial fibrosis, AF ablation is associated with a high procedural failure rate.
Chelu et al. (Tue,) conducted a cohort in Atrial fibrillation (n=308). Left atrial fibrosis assessment by LGE-MRI (Utah stages I-IV) vs. Utah stage I (0-10% fibrosis) was evaluated on First arrhythmia recurrence (HR 2.73, 95% CI 1.57-4.75). Advanced left atrial fibrosis (Utah stage IV vs I) was associated with a higher risk of recurrent atrial fibrillation up to 5 years after ablation (HR 2.73; 95% CI 1.57-4.75).