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Recurrence of Atrial Fibrillation Correlates With the Extent of Post-Procedural Late Gadolinium Enhancement

A Pilot Study

Dana C. Peters, PhD^_*,_*, John V. Wylie, MD, FACC^_*, Thomas H. Hauser, MD, FACC^_*, Reza Nezafat, PhD^_*, Yuchi Han, MD, FACC^_*, Jeong Joo Woo, MD^_*,, Jason Taclas, BS^_*, Kraig V. Kissinger, RT^_*, Beth Goddu, RT^_*, Mark E. Josephson, FACC, MD^_*, Warren J. Manning, MD, FACC^_*,

^_* Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Eulji Hospital, Eulji University School of Medicine, Department of Radiology, Seoul, Korea

^_* Reprint requests and correspondence: Dr. Dana C. Peters, Beth Israel Deaconess Medical Center, Cardiovascular Division, 330 Brookline Avenue, Boston, Massachusetts 02215 (Email: dcpeters{at}bidmc.harvard.edu).

Objectives: We sought to evaluate radiofrequency (RF) ablation lesions in atrial fibrillation (AF) patients using cardiac magnetic resonance (CMR), and to correlate the ablation patterns with treatment success.

Background: RF ablation procedures for treatment of AF result in localized scar that is detected by late gadolinium enhancement (LGE) CMR. We hypothesized that the extent of scar in the left atrium and pulmonary veins (PV) would correlate with moderate-term procedural success.

Methods: Thirty-five patients with AF, undergoing their first RF ablation procedure, were studied. The RF ablation procedure was performed to achieve bidirectional conduction block around each PV ostium. AF recurrence was documented using a 7-day event monitor at multiple intervals during the first year. High spatial resolution 3-dimensional LGE CMR was performed 46 ± 28 days after RF ablation. The extent of scarring around the ostia of each PV was quantitatively (volume of scar) and qualitatively (1: minimal, 3: extensive and circumferential) assessed.

Results: Thirteen (37%) patients had recurrent AF during the 6.7 ± 3.6-month observation period. Paroxysmal AF was a strong predictor of nonrecurrent AF (15% with recurrence vs. 68% without, p = 0.002). Qualitatively, patients without recurrence had more completely circumferentially scarred veins (55% vs. 35% of veins, p = NS). Patients without recurrence more frequently had scar in the inferior portion of the right inferior pulmonary vein (RIPV) (82% vs. 31%, p = 0.025, Bonferroni corrected). The volume of scar in the RIPV was quantitatively greater in patients without AF recurrence (p 0.05) and was a univariate predictor of recurrence using Cox regression (p = 0.049, Bonferroni corrected).

Conclusions: Among patients undergoing PV isolation, AF recurrence during the first year is associated with a lesser degree of PV and left atrial scarring on 3-dimensional LGE CMR. This finding was significant for RIPV scar and may have implications for the procedural technique used in PV isolation.

Key Words: late gadolinium enhancement • catheter ablation • atrial fibrillation • CMR • left atrium

Abbreviations and Acronyms   AF = atrial fibrillation   CMR = cardiac magnetic resonance   PV = pulmonary vein   LA = left atrium/atrial   LGE = late gadolinium enhancement   LIPV = left inferior pulmonary vein   LSPV = left superior pulmonary vein   RIPV = right inferior pulmonary vein   RF = radiofrequency   RSPV = right superior pulmonary vein   ROI = region of interest   3D = 3-dimensional

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