Detection and Quantification of Left Atrial Structural Remodeling Using Delayed Enhancement MRI in Patients with Atrial Fibrillation

By R. Oakes, Troy J. Badger, E. Kholmovski, N. Akoum, N. Burgon, E. Fish, Joshua J. E. Blauer, Swati N. Rao, E. DiBella, N. Segerson and 6 more. Circulation, 2009

993 citations recorded by the source corpus.

Background— Atrial fibrillation (AF) is associated with diffuse left atrial fibrosis and a reduction in endocardial voltage. These changes are indicators of AF severity and appear to be predictors of treatment outcome. In this study, we report the utility of delayed-enhancement magnetic resonance imaging (DE-MRI) in detecting abnormal atrial tissue before radiofrequency ablation and in predicting procedural outcome. Methods and Results— Eighty-one patients presenting for pulmonary vein antrum isolation for treatment of AF underwent 3-dimensional DE-MRI of the left atrium before the ablation. Six healthy volunteers also were scanned. DE-MRI images were manually segmented to isolate the left atrium, and custom software was implemented to quantify the spatial extent of delayed enhancement, which was then compared with the regions of low voltage from electroanatomic maps from the pulmonary vein antrum isolation procedure. Patients were assessed for AF recurrence at least 6 months after pulmonary vein antrum isolation, with an average follow-up of 9.6±3.7 months (range, 6 to 19 months). On the basis of the extent of preablation enhancement, 43 patients were classified as having minimal enhancement (average enhancement, 8.0±4.2%), 30 as having moderate enhancement (21.3±5.8%), and 8 as having extensive enhancement (50.1±15.4%). The rate of AF recurrence was 6 patients (14.0%) with minimal enhancement, 13 (43.3%) with moderate enhancement, and 6 (75%) with extensive enhancement (P<0.001). Conclusions— DE-MRI provides a noninvasive means of assessing left atrial myocardial tissue in patients suffering from AF and might provide insight into the progress of the disease. Preablation DE-MRI holds promise for predicting responders to AF ablation and may provide a metric of overall disease progression.

Subfields: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/1af993e1e93abb72b98be08710ba3016891cd30d

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Citations in the corpus

Catheter ablation of atrial fibrillation in heart failure. (2013, background): “These clinical characteristics are associated with atrial dilatation and fibrosis and decreased procedural success.(66) In view of these findings they performed a post hoc analysis to identify whether patients in SR demonstrated any improvements in cardiac structure or function.”
2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation (2017, methodology): “134,136,139,161,784 In the ventricular myocardium, MRI is an established modality to visualize myocardial inflammation and fibrous tissue by using LGE.134,560,561,785,786 However, highresolution imaging of atrial fibrosis remains technically challenging, with limited reproducibility of accuracy of M”
A global benchmark of algorithms for segmenting the left atrium from late gadolinium-enhanced cardiac magnetic resonance imaging (2020, methodology): “…organ and tissue structure from 3D images, such as those obtained from computed tomography (CT) and magnetic resonance imaging (MRI), is often a necessity for medical diagnosis, patient stratification, and clinical treatment (Medrano-Gracia et al. 2015, Oakes et al. 2009, Csepe et al. 2017).”
2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design (2012, background): “More recent studies from a single-center have demonstrated that the extent of LA fibrosis prior to ablation can predict the outcomes of catheter ablation of AF [98, 354].”