A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes.
Introduction: Multiple cardiac magnetic resonance (CMR)‐derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long‐term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), left ventricular ejection fraction (LV...
| Published in: | Journal of Cardiovascular Electrophysiology Vol. 30; no. 10; pp. 1894 - 1904 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | diagnostic images research tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Oct2019
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139054136&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139054136 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Oct2019 vid: 30 iid: 10 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 139054136 139054136 139054136 10.1111/jce.14111 139054136 ppf: 1894 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes. aug: au: Chubb, Henry Karim, Rashed Mukherjee, Rahul Williams, Steven E. Whitaker, John Harrison, James Niederer, Steven A. Staab, Wieland Gill, Jaspal Schaeffter, Tobias Wright, Matthew O'Neill, Mark Razavi, Reza affil: Division of Imaging Sciences and Biomedical Engineering, King's College London, London UK sug: subj: Catheter Ablation Methods Atrial Fibrillation Surgery Preoperative Care Diagnosis, Cardiovascular Methods Magnetic Resonance Imaging Methods Atrial Fibrillation Diagnosis Recurrence Risk Factors Recurrence Prevention and Control Human Treatment Outcomes Male Female Elements Imaging, Three-Dimensional Methods Fibrosis Diagnosis Heart Atrium, Left Anatomy and Histology Diastole Odds Ratio Cox Proportional Hazards Model Multiple Regression Age Factors Sex Factors Ventricular Ejection Fraction Evaluation Prospective Studies Multivariate Analysis Male Female ab: Introduction: Multiple cardiac magnetic resonance (CMR)‐derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long‐term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), left ventricular ejection fraction (LVEF), LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long‐term single‐center study. Methods and Results: Eighty‐nine patients (53% paroxysmal AF, 73% male) underwent comprehensive CMR study before first‐time AF ablation (median follow‐up 726 days [IQR: 418‐1010 days]). The 3D late gadolinium‐enhanced acquisition (1.5T, 1.3 × 1.3 × 2 mm) was quantified for fibrosis; LA volume and sphericity were assessed on manual segmentation at atrial diastole; LAEF and LVEF were quantified on multislice cine imaging. AF recurred in 43 patients (48%) overall (31 at 1 year). In the recurrence group, LA fibrosis was higher (42% vs 29%; hazard ratio [HR]: 1.032; P = .002), left atrial ejection fraction (LAEF) lower (25% vs 34%; HR: 0.063; P = .016) and LVEF lower (57% vs 63%; HR: 0.011; P = .008). LA volume (135 vs 124 mL) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (Model 1), additionally AF type (Model 2) and combined (Model 3). In Models 1 and 2, LA fibrosis, LAEF, and LVEF were independently associated with outcome, but only LA fibrosis was independent in Model 3 (HR: 1.021; P = .022). Conclusions: LAEF, LVEF, and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome. pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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