PMID- 23356963 OWN - NLM STAT- MEDLINE DCOM- 20130927 LR - 20211021 IS - 1540-8159 (Electronic) IS - 0147-8389 (Print) IS - 0147-8389 (Linking) VI - 36 IP - 4 DP - 2013 Apr TI - The effect of fat pad modification during ablation of atrial fibrillation: late gadolinium enhancement MRI analysis. PG - 467-76 LID - 10.1111/pace.12084 [doi] AB - BACKGROUND: Magnetic resonance imaging (MRI) can visualize locations of both the ablation scar on the left atrium (LA) after atrial fibrillation (AF) ablation and epicardial fat pads (FPs) containing ganglionated plexi (GP). METHODS: We investigated 60 patients who underwent pulmonary vein antrum (PVA) isolation along with LA posterior wall and septal debulking for AF. FPs around the LA surface in well-known GP areas (which were considered as the substitution of GP areas around the LA) were segmented from the dark-blood MRI. Then the FP and the ablation scar image visualized by late gadolinium enhancement (LGE)-MRI on the LA were merged together. Overlapping areas of FP and the ablation scar image were considered as the ablated FP areas containing GP. Patients underwent 24-hour Holter monitoring after ablation for the analysis of heart rate variability. RESULTS: Ablated FP area was significantly wider in patients without AF recurrence than those in patients with recurrence (5.6 +/- 3.1 cm(2) vs 4.2 +/- 2.7 cm(2) , P = 0.03). The mean values of both percentage of differences greater than 50 ms in the RR intervals (pRR > 50) and standard deviation of RR intervals over the entire analyzed period (SDNN), which were obtained from 24-hour Holter monitoring 1-day post-AF ablation, were significantly lower in patients without recurrence than those in patients with recurrence (5.8 +/- 6.0% vs 14.0 +/- 10.1%; P = 0.0005, 78.7 +/- 32.4 ms vs 109.2 +/- 43.5 ms; P = 0.005). There was a significant negative correlation between SDNN and the percentage of ablated FP area (Y = -1.3168X + 118.96, R(2) = 0.1576, P = 0.003). CONCLUSION: Extensively ablating LA covering GP areas along with PVA isolation enhanced the denervation of autonomic nerve system and seemed to improve procedural outcome in patients with AF. CI - (c)2013, The Authors. Journal compilation (c)2013 Wiley Periodicals, Inc. FAU - Higuchi, Koji AU - Higuchi K AD - Comprehensive Arrhythmia and Research Management (CARMA) Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. khigu1013@gmail.com FAU - Akkaya, Mehmet AU - Akkaya M FAU - Koopmann, Matthias AU - Koopmann M FAU - Blauer, Joshua J E AU - Blauer JJ FAU - Burgon, Nathan S AU - Burgon NS FAU - Damal, Kavitha AU - Damal K FAU - Ranjan, Ravi AU - Ranjan R FAU - Kholmovski, Eugene AU - Kholmovski E FAU - Macleod, Rob S AU - Macleod RS FAU - Marrouche, Nassir F AU - Marrouche NF LA - eng GR - K23 HL115084/HL/NHLBI NIH HHS/United States GR - P41 GM103545/GM/NIGMS NIH HHS/United States PT - Journal Article DEP - 20130128 PL - United States TA - Pacing Clin Electrophysiol JT - Pacing and clinical electrophysiology : PACE JID - 7803944 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 15G12L5X8K (gadobenic acid) RN - 6HG8UB2MUY (Meglumine) SB - IM MH - Adipose Tissue/*surgery MH - Aged MH - Atrial Fibrillation/*surgery MH - Catheter Ablation/*methods MH - Chi-Square Distribution MH - Contrast Media MH - Electrocardiography, Ambulatory MH - Female MH - Humans MH - Magnetic Resonance Imaging/*methods MH - Male MH - Meglumine/analogs & derivatives MH - Middle Aged MH - Organometallic Compounds MH - Pericardium/surgery MH - Pulmonary Veins/surgery PMC - PMC3651513 MID - NIHMS463072 EDAT- 2013/01/30 06:00 MHDA- 2013/09/28 06:00 PMCR- 2014/04/01 CRDT- 2013/01/30 06:00 PHST- 2012/09/24 00:00 [received] PHST- 2012/10/26 00:00 [revised] PHST- 2012/12/10 00:00 [accepted] PHST- 2013/01/30 06:00 [entrez] PHST- 2013/01/30 06:00 [pubmed] PHST- 2013/09/28 06:00 [medline] PHST- 2014/04/01 00:00 [pmc-release] AID - 10.1111/pace.12084 [doi] PST - ppublish SO - Pacing Clin Electrophysiol. 2013 Apr;36(4):467-76. doi: 10.1111/pace.12084. Epub 2013 Jan 28.