Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement: a pilot study.
Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement: a pilot study.
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DOI：
10.1016/j.jcmg.2008.10.016
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发表时间：
2009-03
影响因子：
14
通讯作者：
Manning, Warren J.
中科院分区：
文献类型：
--
作者：
Peters, Dana C.;Wylie, John V.;Hauser, Thomas H.;Nezafat, Reza;Han, Yuchi;Woo, Jeong Joo;Taclas, Jason;Kissinger, Kraig V.;Goddu, Beth;Josephson, Mark E.;Manning, Warren J.
我们试图使用心血管磁共振（CMR）评估心房颤动（AF）患者的射频（RF）消融病变，并将消融模式与治疗成功相关联。用于治疗 AF 的射频消融手术会导致局部疤痕，可通过晚期钆增强 (LGE) CMR 检测到。我们假设左心房 (LA) 和肺静脉 (PV) 的疤痕程度与中期手术成功相关。研究人员对 35 名接受首次射频消融手术的 AF 患者进行了研究。进行射频消融手术是为了实现每个 PV 口周围的双向传导阻滞。在第一年中，使用 7 天事件监测器多次间隔记录 AF 复发。射频消融后 46±28 天进行高空间分辨率 3D LGE CMR。对每个 PV 口周围的疤痕程度进行定量（疤痕体积）和定性（1-最小，3-广泛和圆周）评估。在 6.7 ± 3.6 个月的观察期内，13 名 (37%) 患者出现房颤复发。阵发性 AF 是非复发性 AF 的有力预测因子（复发性 AF 为 15%，未复发性 AF 为 68%，p=0.002）。定性地讲，未复发的患者具有更完全的环向疤痕静脉（静脉的 55% 与 35%，p = NS）。未复发的患者更常在右下 PV (RIPV) 下部出现疤痕（82% vs. 31%，p=0.025，Bonferroni 校正）。在没有 AF 复发的患者中，RIPV 中的疤痕体积在数量上更大 (p=<0.05)，并且使用 Cox 回归是复发的单变量预测因子 (p=0.049，Bonferroni 校正)。在接受 PV 隔离的患者中，第一年 AF 复发与 3D LGE CMR 上较小程度的 PV 和 LA 疤痕相关。这一发现对于 RIPV 疤痕具有重要意义，并且可能对 PV 隔离中使用的程序技术产生影响。
We sought to evaluate radiofrequency (RF) ablations lesions in atrial fibrillation (AF) patients using cardiovascular magnetic resonance (CMR), and to correlate the ablation patterns with treatment success. RF ablation procedures for treatment of AF result in localized scar that is detected by late gadolinium enhancement (LGE) CMR. We hypothesized that the extent of scar in the left atrium (LA) and pulmonary veins (PV) would correlate with moderate-term procedural success. Thirty five patients with AF, undergoing their first RF ablation procedure, were studied. The RF ablation procedure was performed to achieve bi-directional conduction block around each PV ostium. AF recurrence was documented using a 7 day event monitor at multiple intervals during the first year. High spatial resolution 3D LGE CMR was performed 46±28 days after RF ablation. The extent of scarring around the ostia of each PV was quantitatively (volume of scar) and qualitatively (1-minimal, 3-extensive and circumferential) assessed. Thirteen (37%) patients had recurrent AF during the 6.7 ± 3.6 month observation period. Paroxysmal AF was a strong predictor of non-recurrent AF (15% with recurrence vs. 68% without, p=0.002). Qualitatively, patients without recurrence had more completely circumferentially scarred veins (55% vs. 35% of veins, p = NS). Patients without recurrence more frequently had scar in the inferior portion of the right inferior PV (RIPV) (82% vs. 31%, p=0.025, Bonferroni corrected). The volume of scar in the RIPV was quantitatively greater in patients without AF recurrence (p=<0.05), and was a univariate predictor of recurrence using Cox regression (p=0.049, Bonferroni corrected). Among patients undergoing PV isolation, AF recurrence during the first year is associated with a lesser degree of PV and LA scarring on 3D LGE CMR. This finding was significant for RIPV scar, and may have implications for the procedural technique used in PV isolation.
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影响因子：
24
作者：
Okada, Taro;Yamada, Takumi;Murohara, Toyoaki
通讯作者：
Murohara, Toyoaki
影响因子：
39.3
作者：
Berruezo, Antonio;Tamborero, David;Brugada, Josep
通讯作者：
Brugada, Josep
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作者：
Reddy, VY;Malchano, ZJ;Ruskin, JN
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Ruskin, JN
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Skanes, A
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Sauer, William H.;McKernan, Melissa L.;Marchlinski, Francis E.
通讯作者：
Marchlinski, Francis E.