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- Open Access
Left atrial scar burden determined by delayed enhancement cardiac magnetic resonance at post radiofrequency ablation: association with atrial fibrillation recurrence
© Brunner et al; licensee BioMed Central Ltd. 2012
- Published: 1 February 2012
- Cardiac Magnetic Resonance
- Left Atrial
- Atrial Fibrillation Patient
- Atrial Fibrillation Recurrence
- Left Ventricle Ejection Fraction
Left atrial (LA) radiofrequency (RF) ablation has become routine treatment for atrial fibrillation (AF) but still suffers from AF recurrence requiring a repeat procedure. LA-RF ablation success rates vary between 53% and 85%. Delayed-enhancement Cardiac Magnetic Resonance (DE-CMR) can be used to noninvasively visualize LA hyperenhancement (scar). We have utilized DE-CMR to quantify LA scar extent post LA-RF-ablation and related this measure to AF recurrence.
Twenty-seven patients (62.0±11.1 years, 20 males) with paroxysmal and chronic AF underwent LA-RF-ablation and subsequent DE-CMR, an average of 260.7±314.7 days post procedure. The DE-CMR procedure was performed utilizing a navigated 3D inversion recovery gradient echo sequence (Siemens 1.5T Avanto or 3.0T Verio) approximately 15 minutes after administration of 0.2 mmol/kg Diethylenetriaminepentaacetic Acid−Gadolinium (DTPA-Gd, Magnevist, Berlex Laboratories, Wayne, NJ). All scans were electrocardiographically (ECG)-gated and acquired during a 150 ms window in mid-diastole with navigator-gating and fat suppression. We have developed an image analysis method and graphical user interface to semi-automatically quantify hyperenhanced regions in the LA wall (scar). LA scar was quantified by a single experienced observer blinded to patient data. LA-scar measurements were normalized by LA size. The intra-class correlation coefficient (ICC) was used to assess intra-observer variability of 4 randomly selected scans which were re-read one week later. Variables were tested for normality with the Shapiro-Wilk test and a p-value<0.05 was considered statistically significant (all tests were 2-sided). All patients provided informed consent.
LA-scar quantification in AF patients.
AF-Recurrence [N=13, mean, std]
AF-Free [N=14, mean, std]
128.49 ± 44.0
96.0 ± 38.5
58.93 ± 12.1
64.85 ± 6.2.1
11.40 ± 7.6
16.56 ± 5.25
61.67 ± 9.3
62.23 ± 12.8
Gender [no. males]
LA scar extent can be reproducibly quantified with DE-CMR; and a lower scar burden post LA-RF-ablation is associated with AF recurrence.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.