Poor scar formation after ablation is associated with atrial fibrillation recurrence
Poor scar formation after ablation is associated with atrial fibrillation recurrence
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DOI：
10.1007/s10840-015-0060-y
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发表时间：
2015-12-01
影响因子：
1.8
通讯作者：
Ranjan, Ravi
中科院分区：
文献类型：
--
作者：
Parmar, Bhrigu R.;Jarrett, Tyler R.;Ranjan, Ravi
心房颤动（AF）患者通常接受消融术治疗，但复发率仍然很高。我们在这项研究中探讨了晚期钆增强磁共振成像（LGE-MRI）显示的瘢痕形成不良是否与消融后房颤复发相关。我们回顾性地确定了94例连续的患者，他们在我们的机构接受了房颤的初始消融，并在手术前的磁共振血管造影（MRA）和左房（LA）的电解剖定位（EAM）系统中进行了手术前的磁共振血管造影（MRA）和左房（LA）解剖，在EAM中标记了消融区域，消融后3个月的lge mri评估疤痕，以及至少3个月的临床随访。在EAM中回顾性量化消融面积，在消融后3个月的LGE-MRI中量化瘢痕面积。平均随访336天，94例患者中有26例发生房颤复发。年龄、高血压和心力衰竭与房颤复发无关，但LA大小和EAM消融面积与LGE-MRI瘢痕面积的差异与房颤高复发率相关。根据多变量分析，EAM消融面积与LGE-MRI瘢痕面积之间每增加1%的差异，房颤复发率就增加7- 9% （p值0.001-0.003）。在房颤消融中，LGE-MRI显示瘢痕形成不良与房颤复发有关。改良的定位和消融技术对于获得理想的LA瘢痕和减少房颤复发是必要的。
Patients routinely undergo ablation for atrial fibrillation (AF) but the recurrence rate remains high. We explored in this study whether poor scar formation as seen on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) correlates with AF recurrence following ablation.We retrospectively identified 94 consecutive patients who underwent their initial ablation for AF at our institution and had pre-procedural magnetic resonance angiography (MRA) merged with left atrial (LA) anatomy in an electroanatomic mapping (EAM) system, ablated areas marked intraprocedurally in EAM, 3-month post-ablation LGE-MRI for assessment of scar, and minimum of 3-months of clinical follow-up. Ablated area was quantified retrospectively in EAM and scarred area was quantified in the 3-month post-ablation LGE-MRI.With the mean follow-up of 336 days, 26 out of 94 patients had AF recurrence. Age, hypertension, and heart failure were not associated with AF recurrence, but LA size and difference between EAM ablated area and LGE-MRI scar area was associated with higher AF recurrence. For each percent higher difference between EAM ablated area and LGE-MRI scar area, there was a 7-9 % higher AF recurrence (p values 0.001-0.003) depending on the multivariate analysis.In AF ablation, poor scar formation as seen on LGE-MRI was associated with AF recurrence. Improved mapping and ablation techniques are necessary to achieve the desired LA scar and reduce AF recurrence.