PMID- 19356576 OWN - NLM STAT- MEDLINE DCOM- 20090702 LR - 20240312 IS - 1876-7591 (Electronic) IS - 1936-878X (Print) IS - 1876-7591 (Linking) VI - 2 IP - 3 DP - 2009 Mar TI - Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement: a pilot study. PG - 308-16 LID - 10.1016/j.jcmg.2008.10.016 [doi] AB - OBJECTIVES: We sought to evaluate radiofrequency (RF) ablation lesions in atrial fibrillation (AF) patients using cardiac magnetic resonance (CMR), and to correlate the ablation patterns with treatment success. BACKGROUND: RF ablation procedures for treatment of AF result in localized scar that is detected by late gadolinium enhancement (LGE) CMR. We hypothesized that the extent of scar in the left atrium and pulmonary veins (PV) would correlate with moderate-term procedural success. METHODS: Thirty-five patients with AF, undergoing their first RF ablation procedure, were studied. The RF ablation procedure was performed to achieve bidirectional conduction block around each PV ostium. AF recurrence was documented using a 7-day event monitor at multiple intervals during the first year. High spatial resolution 3-dimensional LGE CMR was performed 46 +/- 28 days after RF ablation. The extent of scarring around the ostia of each PV was quantitatively (volume of scar) and qualitatively (1: minimal, 3: extensive and circumferential) assessed. RESULTS: Thirteen (37%) patients had recurrent AF during the 6.7 +/- 3.6-month observation period. Paroxysmal AF was a strong predictor of nonrecurrent AF (15% with recurrence vs. 68% without, p = 0.002). Qualitatively, patients without recurrence had more completely circumferentially scarred veins (55% vs. 35% of veins, p = NS). Patients without recurrence more frequently had scar in the inferior portion of the right inferior pulmonary vein (RIPV) (82% vs. 31%, p = 0.025, Bonferroni corrected). The volume of scar in the RIPV was quantitatively greater in patients without AF recurrence (p < or = 0.05) and was a univariate predictor of recurrence using Cox regression (p = 0.049, Bonferroni corrected). CONCLUSIONS: Among patients undergoing PV isolation, AF recurrence during the first year is associated with a lesser degree of PV and left atrial scarring on 3-dimensional LGE CMR. This finding was significant for RIPV scar and may have implications for the procedural technique used in PV isolation. FAU - Peters, Dana C AU - Peters DC AD - Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. dcpeters@bidmc.harvard.edu FAU - Wylie, John V AU - Wylie JV FAU - Hauser, Thomas H AU - Hauser TH FAU - Nezafat, Reza AU - Nezafat R FAU - Han, Yuchi AU - Han Y FAU - Woo, Jeong Joo AU - Woo JJ FAU - Taclas, Jason AU - Taclas J FAU - Kissinger, Kraig V AU - Kissinger KV FAU - Goddu, Beth AU - Goddu B FAU - Josephson, Mark E AU - Josephson ME FAU - Manning, Warren J AU - Manning WJ LA - eng GR - K01 EB004434/EB/NIBIB NIH HHS/United States GR - K01 EB004434-03/EB/NIBIB NIH HHS/United States GR - R01 EB008743/EB/NIBIB NIH HHS/United States GR - K01 EB004434-01A1/EB/NIBIB NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - K2I13DR72L (Gadolinium DTPA) SB - IM CIN - JACC Cardiovasc Imaging. 2009 Mar;2(3):317-8. PMID: 19356577 MH - Adult MH - Aged MH - Atrial Fibrillation/pathology/*surgery MH - Catheter Ablation/*adverse effects MH - Cicatrix/etiology/*pathology MH - *Contrast Media MH - Female MH - *Gadolinium DTPA MH - Heart Atria/pathology/surgery MH - Humans MH - Image Interpretation, Computer-Assisted MH - Imaging, Three-Dimensional MH - Kaplan-Meier Estimate MH - *Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Pilot Projects MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Pulmonary Veins/pathology/*surgery MH - Recurrence MH - Risk Assessment MH - Time Factors MH - Treatment Failure PMC - PMC2703450 MID - NIHMS110849 COIS- Potential conflicts of interest: Dr. Warren Manning receives research support from Philips Medical Systems; Dr. Mark Josephson receives consulting fees from Biosense Webster. Dr. Wylie has served as a speaker for Medtronic, Inc. There are no other disclosures relevant to this article. EDAT- 2009/04/10 09:00 MHDA- 2009/07/03 09:00 PMCR- 2010/03/01 CRDT- 2009/04/10 09:00 PHST- 2008/09/10 00:00 [received] PHST- 2008/10/03 00:00 [revised] PHST- 2008/10/15 00:00 [accepted] PHST- 2009/04/10 09:00 [entrez] PHST- 2009/04/10 09:00 [pubmed] PHST- 2009/07/03 09:00 [medline] PHST- 2010/03/01 00:00 [pmc-release] AID - S1936-878X(08)00550-0 [pii] AID - 10.1016/j.jcmg.2008.10.016 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2009 Mar;2(3):308-16. doi: 10.1016/j.jcmg.2008.10.016.