Lack of regional association between atrial late gadolinium enhancement on cardiac magnetic resonance and atrial fibrillation rotors

• Published in: Heart rhythm Vol. 13; no. 3; pp. 654 - 660
• Main Authors: Chrispin, Jonathan, MD, Gucuk Ipek, Esra, MD, Zahid, Sohail, BS, Prakosa, Adityo, PhD, Habibi, Mohammadali, MD, Spragg, David, MD, FHRS, Marine, Joseph E., MD, FHRS, Ashikaga, Hiroshi, MD, PhD, Rickard, John, MD, Trayanova, Natalia A., PhD, FHRS, Zimmerman, Stefan L., MD, Zipunnikov, Vadim, PhD, Berger, Ronald D., MD, PhD, FHRS, Calkins, Hugh, MD, FHRS, Nazarian, Saman, MD, PhD, FHRS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial Function, Left - physiology; Cardiovascular; Catheter Ablation; Delayed enhancement magnetic resonance imaging; Electrocardiography; Female; Fibrosis; Follow-Up Studies; Gadolinium - pharmacology; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Conduction System - diagnostic imaging; Heart Conduction System - physiopathology; Humans; Imaging, Three-Dimensional - methods; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Reproducibility of Results; Rotor; Time Factors; right atrium/atrial; AF; CMR; LGE; Rotor; complex fractionated electrogram; RA; 3D; left atrium/atrial; atrial fibrillation; IIR; LA; Fibrosis; CFAE; late gadolinium enhancement; 3-dimensional; cardiac magnetic resonance; image intensity ratio; FIRM; focal impulse and rotor modulation; Delayed enhancement magnetic resonance imaging; Atrial fibrillation
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2015.11.011

Background The extent of left atrial (LA) late gadolinium enhancement (LGE), as a surrogate for fibrosis, has been associated with atrial fibrillation (AF) recurrence after catheter ablation. Furthermore, there is ex vivo evidence that islands of fibrosis may anchor fibrillatory rotors. Objective The purpose of this study was to examine the anatomical association of AF rotors with LA and right atrial (RA) LGE on cardiac magnetic resonance. Methods The cohort included 9 patients with persistent AF (mean age 61.1 ± 9.7 years) who underwent LGE cardiac magnetic resonance before AF ablation using the focal impulse and rotor modulation system. The extent of LA and RA LGE was quantified globally and in each of the 7 sectors: LA posterior/inferior wall, anterior wall, roof, left and right pulmonary vein antra, and RA lateral and septal regions. The multivariable association of rotor incidence with global and per sector LGE extent was examined using multivariable Bernoulli logistic regression estimated by generalized estimating equations. Results The mean RA and LA volumes were 113.2 ± 37.31 and 143.03 ± 58.25 mL, respectively. The mean RA and LA LGE burden was 17.2% ± 11.0% and 17.4% ± 14.4%, respectively. A total of 18 LA rotors and 9 RA rotors were identified in all patients. No univariable or multivariable association was observed between global or per sector LGE extent and focal impulse and rotor modulation rotor incidence. Conclusion In this cohort of patients, there was no association between AF rotor incidence and the global or regional extent of RA and LA LGE.