Author + information
- Received August 17, 2017
- Revision received October 23, 2017
- Accepted November 16, 2017
- Published online January 17, 2018.
- Luisa Ciuffo, MDa,
- Susumu Tao, MD, PhDa,
- Esra Gucuk Ipek, MDa,
- Tarek Zghaib, MDa,
- Muhammad Balouch, MDa,
- Joao A.C. Lima, MDa,b,c,
- Saman Nazarian, MD, PhDd,
- David D. Spragg, MDa,
- Joseph E. Marine, MDa,
- Ronald D. Berger, MD, PhDa,e,
- Hugh Calkins, MDa and
- Hiroshi Ashikaga, MD, PhDa,∗ ()
- aDivision of Cardiology, Baltimore, Maryland
- bThe Russell H. Morgan Department of Radiology and Radiological Sciences, Baltimore, Maryland
- cDepartment of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
- dSection for Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- eDepartment of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Hiroshi Ashikaga, Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Carnegie 568, Baltimore, Maryland 21287.
Objectives The purpose of this study was to evaluate the usefulness of intra-atrial dyssynchrony as a marker of underlying left atrial (LA) remodeling to predict recurrence after the first atrial fibrillation (AF) ablation.
Background Catheter ablation for AF remains far from curative with relatively high recurrence rates. One of the causes of recurrence is poor patient selection out of a diverse patient population with different degrees of LA remodeling.
Methods We included 208 patients with a history of AF (59.4 ± 10 years of age; 26.0% nonparoxysmal AF) referred for catheter ablation of AF who underwent pre-ablation cardiac magnetic resonance in sinus rhythm. Clinical follow-up was 20 ± 6 months. Using tissue tracking cardiac magnetic resonance, we measured the LA longitudinal strain in each of 12 equal-length segments in 2- and 4-chamber views. We defined intra-atrial dyssynchrony as the standard deviation of the time to the peak longitudinal strain corrected by the cycle length (SD-time to peak strain [TPS], %).
Results Patients with AF recurrence after ablation (n = 101) had significantly higher SD-TPS than those without (n = 107; 3.9% vs. 2.2%; p < 0.001). Multivariable cox analysis showed that SD-TPS was associated with recurrence after adjusting for clinical risk factors, AF type, LA structure and function, and fibrosis (p < 0.001). Furthermore, receiver-operator characteristics analysis showed SD-TPS improved prediction of recurrence better than clinical risk factors, LA structure and function, and fibrosis.
Conclusions Intra-atrial dyssynchrony during sinus rhythm is an independent predictor of recurrence after the first catheter ablation of paroxysmal or persistent AF. Assessment of intra-atrial dyssynchrony may improve ablation outcomes by refining patient selection.
This work was supported by research grants from NIH/NHLBI R56 HL138429 (to Dr. Ashikaga), W.W. Smith Charitable Trust (to Dr. Ashikaga), Magic That Matters Fund for Cardiovascular Research (to Dr. Ashikaga), Zegar Family Foundation (to Dr. Ashikaga), Johns Hopkins University Institute of Clinical and Translational Research (to Dr. Ashikaga), the Edward St. John Foundation for AF Research (to Dr. Calkins), The Roz and Marvin H Weiner and Family Foundation (to Dr. Calkins), The Dr. Francis P. Chiaramonte Foundation (to Dr. Calkins), The Marilyn and Christian Poindexter Arrhythmia Research Fund (to Dr. Calkins), and The Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund (to Dr. Calkins). Dr. Nazarian has received a research grant and served as a consultant for Biosense Weber; has served as the PI for national studies with St. Jude Medical; and has served as a consultant for CardioSolv and Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 17, 2017.
- Revision received October 23, 2017.
- Accepted November 16, 2017.
- 2018 American College of Cardiology Foundation
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