Echocardiographic left atrial reverse remodeling after catheter ablation of atrial fibrillation is predicted by preablation delayed enhancement of left atrium by magnetic resonance imaging

• Published in: The American heart journal Vol. 160; no. 5; pp. 877 - 884
• Main Authors: Kuppahally, Suman S., MD, Akoum, Nazem, MD, Badger, Troy J., MD, Burgon, Nathan S., BS, Haslam, Thomas, BS, Kholmovski, Eugene, PhD, Macleod, Rob, PhD, McGann, Christopher, MD, Marrouche, Nassir F., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2010; Mosby; Elsevier Limited
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial Function, Left - physiology; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Catheter Ablation - methods; Catheters; Cross-Sectional Studies; Echocardiography, Doppler, Color - methods; Female; Follow-Up Studies; Health Insurance Portability & Accountability Act 1996-US; Heart; Heart Atria - diagnostic imaging; Heart Atria - pathology; Heart Atria - physiopathology; Heart rate; Humans; Image Enhancement; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; NMR; Nuclear magnetic resonance; Patients; Preoperative Care - methods; Prognosis; Prospective Studies; Severity of Illness Index; Studies; Ultrasonic investigative techniques; Ventricular Remodeling - physiology; Sonography; Echocardiography; Arrhythmia; Atrial fibrillation; Catheter; Cardiovascular disease; Left atrium; Ablation; Nuclear magnetic resonance imaging; Excitability disorder; Delay; Vascular remodeling; Heart disease; Medical imagery; Circulatory system; Cardiology; Predictive factor
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2010.07.003

Background Atrial fibrosis is a hallmark of atrial structural remodeling (SRM) and leads to structural and functional impairment of left atrial (LA) and persistence of atrial fibrillation (AF). This study was conducted to assess LA reverse remodeling after catheter ablation of AF in mild and moderate-severe LA SRM. Methods Catheter ablation was performed in 68 patients (age 62 ± 14 years, 68% males) with paroxysmal (n = 26) and persistent (n = 42) AF. The patients were divided into group 1 with mild LA SRM (<10%, n = 31) and group 2 with moderate-severe LA SRM (>10%, n = 37) by delayed enhancement magnetic resonance imaging (DEMRI). Two-dimensional echocardiography, LA strain, and strain rate during left ventricular systole by velocity vector imaging were performed pre and at 6 ± 3 months postablation. The long-term outcome was monitored for 12 months. Results Patients in group 1 were younger (57 ± 15 vs 66 ± 13 years, P = .009) with a male predominance (80% vs 57%, P < .05) as compared to group 2. Postablation, group 1 had significant increase in average LA strain (Δ↑: 14% vs 4%, P < .05) and strain rate (Δ↑: 0.5 vs 0.1 cm/s, P < .05) as compared to group 2. There was a trend toward more patients with persistent AF in group 2 (68% vs 55%, P = .2), but it was not statistically significant. Group 2 had more AF recurrences (41% vs 16%, P = .02) at 12 months after ablation. Conclusion Mild preablation LA SRM by DEMRI predicts favorable LA structural and functional reverse remodeling and long-term success after catheter ablation of AF, irrespective of the paroxysmal or persistent nature of AF.