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

• DOI: 10.1161/circulationaha.108.811877
• Publication Date: 2009-03-24T01:54:20Z
• Authors: Robert S. Oakes; Troy J. Badger; Eugene G. Kholmovski; Nazem Akoum; Nathan S. Burgon; Eric N. Fish; Joshua J.E. Blauer; Swati N. Rao; Edward V.R. DiBella; Nathan M. Segerson; Marcos Daccarett; Jessiciah Windfelder; Christopher J. Mc...; Dennis Parker; Rob S. MacLeod; Nassir F. Marrouche
• Keywords: Male; Myocardium; Middle Aged; Combined Modality Therapy; Fibrosis; Magnetic Resonance Imaging; 3. Good health; 03 medical and health sciences; Imaging, Three-Dimensional; Treatment Outcome; 0302 clinical medicine; Predictive Value of Tests; Atrial Fibrillation; Multivariate Analysis; Catheter Ablation; Disease Progression; Humans; Female; Heart Atria; Anti-Arrhythmia Agents; Aged; Proportional Hazards Models

Atrial fibrillation (AF) is associated with diffuse left atrial fibrosis and a reduction in endocardial voltage. These changes are indicators of AF severity appear to be predictors treatment outcome. In this study, we report the utility delayed-enhancement magnetic resonance imaging (DE-MRI) detecting abnormal tissue before radiofrequency ablation predicting procedural outcome.Eighty-one patients presenting for pulmonary vein antrum isolation underwent 3-dimensional DE-MRI atrium ablation. Six healthy volunteers also were scanned. images manually segmented isolate atrium, custom software was implemented quantify spatial extent delayed enhancement, which then compared regions low voltage from electroanatomic maps procedure. Patients assessed recurrence at least 6 months after isolation, an average follow-up 9.6+/-3.7 (range, 19 months). On basis preablation 43 classified as having minimal enhancement (average 8.0+/-4.2%), 30 moderate (21.3+/-5.8%), 8 extensive (50.1+/-15.4%). The rate (14.0%) 13 (43.3%) (75%) (P<0.001).DE-MRI provides noninvasive means assessing myocardial suffering might provide insight into progress disease. Preablation holds promise responders may metric overall disease progression.