PMID- 26777218 OWN - NLM STAT- MEDLINE DCOM- 20161110 LR - 20240324 IS - 1876-7591 (Electronic) IS - 1936-878X (Print) IS - 1876-7591 (Linking) VI - 9 IP - 2 DP - 2016 Feb TI - Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF. PG - 142-8 LID - S1936-878X(15)00963-8 [pii] LID - 10.1016/j.jcmg.2015.10.015 [doi] AB - OBJECTIVES: The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence. BACKGROUND: Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial LGE on cardiac magnetic resonance. Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE. METHODS: The cohort included 165 participants (mean age 60.0 +/- 10.2 years, 77% men, 57% with persistent AF) who underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazards models. Multiplicative and additive interactions between AF type and LGE extent were examined. RESULTS: During 10.2 +/- 5.7 months of follow-up, 63 patients (38.2%) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10% increased LGE; p < 0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction. CONCLUSIONS: Regardless of AF persistence at baseline, participants with LGE 35% have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for: 1) patient selection for AF ablation using LGE extent; and 2) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35% of left atrial myocardium. CI - Copyright (c) 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Khurram, Irfan M AU - Khurram IM AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Habibi, Mohammadali AU - Habibi M AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Gucuk Ipek, Esra AU - Gucuk Ipek E AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Chrispin, Jonathan AU - Chrispin J AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Yang, Eunice AU - Yang E AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Fukumoto, Kotaro AU - Fukumoto K AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Dewire, Jane AU - Dewire J AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Spragg, David D AU - Spragg DD AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Marine, Joseph E AU - Marine JE AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Berger, Ronald D AU - Berger RD AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland. FAU - Ashikaga, Hiroshi AU - Ashikaga H AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland. FAU - Rickard, Jack AU - Rickard J AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Zhang, Yiyi AU - Zhang Y AD - Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. FAU - Zipunnikov, Vadim AU - Zipunnikov V AD - Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland. FAU - Zimmerman, Stefan L AU - Zimmerman SL AD - Department of Radiology, Johns Hopkins University, Baltimore, Maryland. FAU - Calkins, Hugh AU - Calkins H AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. FAU - Nazarian, Saman AU - Nazarian S AD - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: snazarian@jhmi.edu. LA - eng GR - K23 HL089333/HL/NHLBI NIH HHS/United States GR - R01 HL116280/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20160106 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. 2016 Feb;9(2):149-51. PMID: 26777219 MH - Aged MH - Atrial Fibrillation/diagnosis/physiopathology/*surgery MH - Catheter Ablation/*adverse effects MH - Chi-Square Distribution MH - Contrast Media MH - Female MH - Gadolinium DTPA MH - Heart Atria/pathology/physiopathology/*surgery MH - Humans MH - Kaplan-Meier Estimate MH - *Magnetic Resonance Angiography MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Patient Selection MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Prospective Studies MH - Pulmonary Veins/pathology/physiopathology/*surgery MH - Recurrence MH - Risk Factors MH - Time Factors MH - Treatment Outcome PMC - PMC4744105 MID - NIHMS743889 OTO - NOTNLM OT - atrial fibrillation OT - catheter ablation OT - late gadolinium enhancement OT - magnetic resonance imaging EDAT- 2016/01/19 06:00 MHDA- 2016/11/12 06:00 PMCR- 2017/02/01 CRDT- 2016/01/19 06:00 PHST- 2015/05/27 00:00 [received] PHST- 2015/09/16 00:00 [revised] PHST- 2015/10/08 00:00 [accepted] PHST- 2016/01/19 06:00 [entrez] PHST- 2016/01/19 06:00 [pubmed] PHST- 2016/11/12 06:00 [medline] PHST- 2017/02/01 00:00 [pmc-release] AID - S1936-878X(15)00963-8 [pii] AID - 10.1016/j.jcmg.2015.10.015 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2016 Feb;9(2):142-8. doi: 10.1016/j.jcmg.2015.10.015. Epub 2016 Jan 6.