Detection and Quantification of Left Atrial Structural Remodeling With Delayed-Enhancement Magnetic Resonance Imaging in Patients With Atrial Fibrillation

Atrial fibrillation (AF) is associated with diffuse left atrial fibrosis and a reduction in endocardial voltage. These changes are indicators of AF severity and appear to be predictors of treatment outcome. In this study, we report the utility of delayed-enhancement magnetic resonance imaging (DE-MR...

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Published in:Circulation (New York, N.Y.) N.Y.), 2009-04, Vol.119 (13), p.1758-1767
Main Authors: OAKES, Robert S, BADGER, Troy J, DACCARETT, Marcos, WINDFELDER, Jessiciah, MCGANN, Christopher J, PARKER, Dennis, MACLEOD, Rob S, MARROUCHE, Nassir F, KHOLMOVSKI, Eugene G, AKOUM, Nazem, BURGON, Nathan S, FISH, Eric N, BLAUER, Joshua J. E, RAO, Swati N, DIBELLA, Edward V. R, SEGERSON, Nathan M
Format: Article
Language:English
Subjects:
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy
Atrial Fibrillation - pathology
Atrial Fibrillation - surgery
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular system
Catheter Ablation
Combined Modality Therapy
Disease Progression
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Female
Fibrosis
Heart Atria - pathology
Heart Atria - surgery
Humans
Imaging, Three-Dimensional
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Imaging - methods
Male
Medical sciences
Middle Aged
Multivariate Analysis
Myocardium - pathology
Predictive Value of Tests
Proportional Hazards Models
Radionuclide investigations
Treatment Outcome
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Summary:Atrial fibrillation (AF) is associated with diffuse left atrial fibrosis and a reduction in endocardial voltage. These changes are indicators of AF severity and appear to be predictors of treatment outcome. In this study, we report the utility of delayed-enhancement magnetic resonance imaging (DE-MRI) in detecting abnormal atrial tissue before radiofrequency ablation and in predicting procedural outcome. Eighty-one patients presenting for pulmonary vein antrum isolation for treatment of AF underwent 3-dimensional DE-MRI of the left atrium before the ablation. Six healthy volunteers also were scanned. DE-MRI images were manually segmented to isolate the left atrium, and custom software was implemented to quantify the spatial extent of delayed enhancement, which was then compared with the regions of low voltage from electroanatomic maps from the pulmonary vein antrum isolation procedure. Patients were assessed for AF recurrence at least 6 months after pulmonary vein antrum isolation, with an average follow-up of 9.6+/-3.7 months (range, 6 to 19 months). On the basis of the extent of preablation enhancement, 43 patients were classified as having minimal enhancement (average enhancement, 8.0+/-4.2%), 30 as having moderate enhancement (21.3+/-5.8%), and 8 as having extensive enhancement (50.1+/-15.4%). The rate of AF recurrence was 6 patients (14.0%) with minimal enhancement, 13 (43.3%) with moderate enhancement, and 6 (75%) with extensive enhancement (P
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.108.811877