Author + information
- Received May 27, 2015
- Revision received September 16, 2015
- Accepted October 8, 2015
- Published online February 1, 2016.
- Irfan M. Khurram, MDa,
- Mohammadali Habibi, MDa,
- Esra Gucuk Ipek, MDa,
- Jonathan Chrispin, MDa,
- Eunice Yang, MDa,
- Kotaro Fukumoto, MDa,
- Jane Dewire, BAa,
- David D. Spragg, MDa,
- Joseph E. Marine, MDa,
- Ronald D. Berger, MD, PhDa,b,
- Hiroshi Ashikaga, MD, PhDa,b,
- Jack Rickard, MD, MPHa,
- Yiyi Zhang, PhDc,
- Vadim Zipunnikov, PhDd,
- Stefan L. Zimmerman, MDe,
- Hugh Calkins, MDa and
- Saman Nazarian, MD, PhDa,c,∗ ()
- aDivision of Cardiology, Johns Hopkins University, Baltimore, Maryland
- bDepartment of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
- cDepartment of Epidemiology, Johns Hopkins University, Baltimore, Maryland
- dDepartment of Biostatistics, Johns Hopkins University, Baltimore, Maryland
- eDepartment of Radiology, Johns Hopkins University, Baltimore, Maryland
- ↵∗Reprint requests and correspondence:
Dr. Saman Nazarian, Johns Hopkins University, 600 N. Wolfe Street, Halsted 576, Baltimore, Maryland 21287.
Objectives The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence.
Background Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial LGE on cardiac magnetic resonance. Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE.
Methods The cohort included 165 participants (mean age 60.0 ± 10.2 years, 77% men, 57% with persistent AF) who underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazards models. Multiplicative and additive interactions between AF type and LGE extent were examined.
Results During 10.2 ± 5.7 months of follow-up, 63 patients (38.2%) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10% increased LGE; p < 0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction.
Conclusions Regardless of AF persistence at baseline, participants with LGE ≤35% have favorable outcomes, whereas those with LGE >35% have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for: 1) patient selection for AF ablation using LGE extent; and 2) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35% of left atrial myocardium.
This study was funded by National Institutes of Health grants K23HL089333 and R01HL116280 and a Biosense Webster grant to Dr. Nazarian, the Dr. Francis P. Chiaramonte Foundation, The Norbert and Louise Grunwald Cardiac Arrhythmia Fund, the Marv Weiner Cardiac Arrhythmia Fund, and the Marilyn and Christian Poindexter Research Fund. Dr. Rickard is a consultant to Medtronic; and has served as a speaker for St. Jude Medical. Dr. Calkins is a consultant to Medtronic and St. Jude Medical; and has received research support from St. Jude Medical. Dr. Nazarian is a scientific advisor to Medtronic, CardioSolv, and Biosense Webster; and principal investigator for research funding to Johns Hopkins University from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 27, 2015.
- Revision received September 16, 2015.
- Accepted October 8, 2015.
- American College of Cardiology Foundation