Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF.
Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF.
复制标题
DOI：
10.1016/j.jcmg.2015.10.015
复制
发表时间：
2016-02
期刊：
影响因子：
--
通讯作者：
Nazarian S
中科院分区：
文献类型：
--
作者：
Khurram IM;Habibi M;Gucuk Ipek E;Chrispin J;Yang E;Fukumoto K;Dewire J;Spragg DD;Marine JE;Berger RD;Ashikaga H;Rickard J;Zhang Y;Zipunnikov V;Zimmerman SL;Calkins H;Nazarian S
我们试图a）使用一种新的晚期钆增强（LGE）量化方法，该方法利用标准化强度测量来确认LGE程度与消融后房颤（AF）复发之间的相关性，以及B）检查LGE与AF持续性之间是否存在相互作用和效应改变。据报告，导管消融术后复发性AF与心脏磁共振（CMR）上左心房（LA）LGE的基线范围相关。用于测量强度的传统方法缺乏用于定量和患者间LGE比较的客观阈值。该队列包括165名接受初始AF消融术的受试者（60.0±10.2岁，77%为男性，57%为持续性AF）。使用多变量考克斯比例风险模型检查基线LGE程度与AF复发的相关性。AF类型和LGE程度之间的乘法和加法相互作用进行了研究。在10.2±5.7个月的随访期间，63例（38.2%）患者发生AF复发。校正混杂因素后，基线LGE程度与AF复发独立相关[LGE每增加10%，风险比（HR）1.5，P<0.001]。房颤复发的HR随着LGE的增加而逐渐增加。在持续性房颤患者中，LGE >35%与房颤复发之间的关联程度更大（HR 6.5，P=0.001 vs HR 3.6，P=0.001）;然而，没有统计学相互作用的证据。无论基线时房颤持续性如何，LGE ≤ 35%的受试者具有良好的结局，而LGE > 35%的受试者在消融术后第一年的房颤复发率较高。这些结果表明，a）使用LGE范围选择AF消融的患者，和B）LGE范围超过35% LA心肌的患者中，除了肺静脉隔离外，还进行底物修饰。
We sought to a) use a novel method of late gadolinium enhancement (LGE) quantification that utilizes normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation, and b) examine the presence of interaction and effect modification between LGE and AF persistence. Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial (LA) LGE on cardiac magnetic resonance (CMR). Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE. The cohort included 165 participants (60.0±10.2 years, 77% men, 57% persistent AF) that underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazard models. Multiplicative and additive interaction between AF type and LGE extent were examined. During 10.2±5.7 months of follow-up, 63 (38.2%) patients experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders [hazard ratio (HR) 1.5 per 10% increased LGE, P<0.001]. The HR for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (HR 6.5, P=0.001 versus HR 3.6, P=0.001); however, there was no evidence for statistical interaction. Regardless of AF persistence at baseline, participants with LGE ≤ 35% have a favorable outcome, whereas those with LGE > 35% have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for a) patient selection for AF ablation using LGE extent, and b) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35% of LA myocardium.