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Cochet, H; Scherr, D; Zellerhoff, S; Sacher, F; Derval, N; Denis, A; Knecht, S; Komatsu, Y; Montaudon, M; Laurent, F; Pieske, BM; Hocini, M; Haïssaguerre, M; Jaïs, P.
Atrial structure and function 5 years after successful ablation for persistent atrial fibrillation: an MRI study.
J Cardiovasc Electrophysiol. 2014; 25(7):671-679
Doi: 10.1111/jce.12449
Web of Science
PubMed
FullText
FullText_MUG
- Führende Autor*innen der Med Uni Graz
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Scherr Daniel
- Co-Autor*innen der Med Uni Graz
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Pieske Burkert Mathias
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- Abstract:
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The atrial outcome after extensive ablation is unknown. We sought to quantify atrial structure and function years after successful ablation for persistent atrial fibrillation (PsAF).
We studied after 80 ± 15 months 26 patients (54 ± 8 years, 1 woman) with PsAF successfully treated by ablation (2.2 ± 0.7 stepwise approach procedures, cumulative RF duration 126 ± 37 minutes). At follow-up atrial scar burden and atrial outflows were quantified using delayed-enhanced and velocity-encoded MRI, respectively. Cine imaging was used to quantify atrial conduit function (CF), active emptying fraction (AEF), expansion index (EI), and the inter-appendage mechanical activation delay. Patients underwent exercise testing at baseline and follow-up. LA and RA scar extent were 29 ± 6 and 4.3 ± 2.8%, respectively. LA and RA AEF were 10.0 ± 5.3 and 30 ± 8%. Mean inter-appendage delay was 83 ± 47 ms [42-217]. Complete LAA isolation was found in 3 patients. A wave was absent in 9/26 patients. LA scar extent related to the number of procedures (R = 0.58, P = 0.002) and total RF duration (R = 0.56, P = 0.003). Among follow-up characteristics, LA scar extent related to LAAEF (R = -0.73, P < 0.0001), LAEI (R = -0.64, P = 0.0003), A-wave peak (R = -0.72, P < 0.0001), and inter-appendage mechanical delay (R = 0.47, P = 0.02). At multivariable analysis, LA scar extent was independently related to LAAEF and LAEI. LAAEF and LA scar extent correlated with exercise capacity at follow-up (R = 0.44, P = 0.02, and R = -0.40; P = 0.04).
LA contractility and compliance are markedly impaired years after successful PsAF ablation. LA dysfunction is closely related to scar burden.
© 2014 Wiley Periodicals, Inc.
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Action Potentials -
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Adult -
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Aged -
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Atrial Fibrillation - pathology
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Atrial Fibrillation - physiopathology
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Atrial Fibrillation - surgery
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Atrial Function, Left -
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Atrial Remodeling -
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Catheter Ablation - adverse effects
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Cicatrix - etiology
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Cicatrix - pathology
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Cicatrix - physiopathology
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Compliance -
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Exercise Test -
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Female -
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Heart Atria - pathology
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Heart Atria - physiopathology
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Heart Atria - surgery
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Humans -
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Magnetic Resonance Imaging, Cine -
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Male -
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Middle Aged -
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Multivariate Analysis -
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Myocardial Contraction -
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Time Factors -
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Treatment Outcome -
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atrial fibrillation
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atrial remodeling
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catheter ablation
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magnetic resonance imaging