Recurrence of Atrial Fibrillation Correlates With the Extent of Post-Procedural Late Gadolinium EnhancementA 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
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Figure 1 Methodology for Measuring Scar Volumes
(A) Original late gadolinium enhancement images of scar with hyperenhanced scar. (B) Scar is highlighted (in red) using signal thresholding, separating scar from normal tissues. (C) Regions of interest (ROIs) are used to identify scar on each slice as belonging to the left inferior pulmonary vein (LIPV), right inferior pulmonary vein (RIPV), left superior pulmonary vein, right superior pulmonary vein, and posterior wall. (D) Each slice is analyzed using thresholding ands ROIs to identify scarred pixels in each region. (E) Total scar is summed over all slices.
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Figure 2 3-Dimensional LGE Images in 3 Patients, With a Volume-Rendered View
Three patients, 2 without recurrence of atrial fibrillation (A and B) and 1 with recurrence of atrial fibrillation (C). Top panels show a late gadolinium enhancement (LGE) slice from the 3-dimensional (3D) volume. Bottom panels show planar reformats across pulmonary vein ostia. The orientation is shown in bottom panel B. The reformats provide examples of qualitative gradings for the RIPV of (A) 3: complete; (B) 2: partial; and (C) 1: no scar. (D) A 3D volume-rendering of the scar for Patient B. A mitral isthmus line is observed (arrow) (Online Video 1). A = anterior; AAo = ascending aorta; Ao = aorta; F = foot; H = head; LA = left atrium; LSPV = left superior pulmonary vein; p = posterior; RA = right atrium; RSPV = right superior pulmonary vein; other abbreviations as in Figure 1.
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Figure 3 Kaplan-Meier AF Free Survival Curve Stratified by RIPV Scar
Kaplan-Meier survival curve showing atrial fibrillation (AF)-free survival time for patients using median scar volume cutoffs (1.98 ml), for patients with greater and lesser right inferior pulmonary vein (RIPV) scar volume measurement. More extensive scarring was associated with longer AF-free survival (p = 0.029).
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