Atrial fibrillation ablation outcome is predicted by left atrial remodeling on MRI

Christopher McGann*, Nazem Akoum, Amit Patel, Eugene Kholmovski, Patricia Revelo, Kavitha Damal, Brent Wilson, Josh Cates, Alexis Harrison, Ravi Ranjan, Nathan S. Burgon, Tom Greene, Dan Kim, Edward V R DiBella, Dennis Parker, Rob S. MacLeod, Nassir F. Marrouche

*Corresponding author for this work

Research output: Contribution to journalArticle

195 Scopus citations

Abstract

Background-Although catheter ablation therapy for atrial fibrillation (AF) is becoming more common, results vary widely, and patient selection criteria remain poorly defined. We hypothesized that late gadolinium enhancement MRI (LGE-MRI) can identify left atrial (LA) wall structural remodeling (SRM) and stratify patients who are likely or not to benefit from ablation therapy. Methods and Results-LGE-MRI was performed on 426 consecutive patients with AF without contraindications to MRI before undergoing their first ablation procedure and on 21 non-AF control subjects. Patients were categorized by SRM stage (I-IV) based on the percentage of LA wall enhancement for correlation with procedure outcomes. Histological validation of SRM was performed comparing LGE-MRI with surgical biopsy. A total of 386 patients (91%) with adequate LGE-MRI scans were included in the study. After ablation, 123 patients (31.9%) experienced recurrent atrial arrhythmias during the 1-year follow-up. Recurrent arrhythmias (failed ablations) occurred at higher SRM stages with 28 of 133 (21.0%) in stage I, 40 of 140 (29.3%) in stage II, 24 of 71 (33.8%) in stage III, and 30 of 42 (71.4%) in stage IV. In multivariate analysis, ablation outcome was best predicted by advanced SRM stage (hazard ratio, 4.89; P<0.0001) and diabetes mellitus (hazard ratio, 1.64; P=0.036), whereas increased LA volume and persistent AF were not significant predictors. LA wall enhancement was significantly greater in patients with AF versus non-AF controls (16.6±11.2% versus 3.1±1.9%; P<0.0001). Histological evidence of remodeling from surgical biopsy specimens correlated with SRM on LGE-MRI. Conclusions-Atrial SRM is identified on LGE-MRI, and extensive LGE (=30% LA wall enhancement) predicts poor response to catheter ablation therapy for AF.

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number1
DOIs
StatePublished - Feb 2014

Keywords

  • Atrial remodeling
  • Catheter ablation
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    McGann, C., Akoum, N., Patel, A., Kholmovski, E., Revelo, P., Damal, K., Wilson, B., Cates, J., Harrison, A., Ranjan, R., Burgon, N. S., Greene, T., Kim, D., DiBella, E. V. R., Parker, D., MacLeod, R. S., & Marrouche, N. F. (2014). Atrial fibrillation ablation outcome is predicted by left atrial remodeling on MRI. Circulation: Arrhythmia and Electrophysiology, 7(1), 23-30. https://doi.org/10.1161/CIRCEP.113.000689