Atrial fibrillation ablation outcome is predicted by left atrial remodeling on MRI.
Atrial fibrillation ablation outcome is predicted by left atrial remodeling on MRI.
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DOI：
10.1161/circep.113.000689
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发表时间：
2014-02
期刊：
影响因子：
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通讯作者：
Marrouche NF
中科院分区：
文献类型：
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作者：
McGann C;Akoum N;Patel A;Kholmovski E;Revelo P;Damal K;Wilson B;Cates J;Harrison A;Ranjan R;Burgon NS;Greene T;Kim D;Dibella EV;Parker D;Macleod RS;Marrouche NF
虽然房颤（AF）的导管消融治疗变得越来越普遍，但结果差异很大，患者选择标准仍然定义不清。我们假设晚期钆增强磁共振成像（LGE-MRI）可以识别左心房（LA）壁结构重构（SRM），并对可能或不可能从消融治疗中受益的患者进行分层。对426例无MRI禁忌症的连续AF患者和21例非AF对照受试者在首次消融术前进行了LGE-MRI。根据与手术结局相关的左心房壁增强百分比，按SRM分期（I-IV）对患者进行分类。将LGE-MRI与手术活检进行比较，对SRM进行组织学验证。共有386例患者（91%）接受了充分的LGE-MRI扫描。消融术后，123例（31.9%）患者在一年随访期间复发房性心律失常。复发性心律失常（消融失败）发生在较高SRM分期，28/133（21.0%）I期、40/140（29.3%）II期、24/71（33.8%）III期和30/42（71.4%）IV期。在多变量分析中，晚期SRM分期（风险比（HR）4.89; p<0.0001）和糖尿病（HR 1.64; p=0.036）是消融结局的最佳预测因素，而左心房容量增加和持续性房颤不是显著的预测因素。AF患者的左心房壁增强显著大于非AF对照组（16.6±11.2% vs. 3.1± 1.9%，p<0.0001）。来自手术活检标本的重塑的组织学证据与LGE-MRI上的SRM相关。在LGE-MRI上识别出心房SRM，广泛LGE（≥30% LA壁增强）预测对AF导管消融治疗的反应较差。
While catheter ablation therapy for atrial fibrillation (AF) is becoming more common, results vary widely and patient selection criteria remain poorly defined. We hypothesized that late gadolinium enhancement magnetic resonance imaging (LGE-MRI) can identify left atrial (LA) wall structural remodeling (SRM) and stratify patients who are likely or not to benefit from ablation therapy. LGE-MRI was performed on 426 consecutive AF patients without contraindications to MRI and before undergoing their first ablation procedure and on 21 non-AF control subjects. Patients were categorized by SRM stage (I–IV) based on percentage of LA wall enhancement for correlation with procedure outcomes. Histological validation of SRM was performed comparing LGE-MRI to surgical biopsy. A total of 386 patients (91%) with adequate LGE-MRI scans were included in the study. Post-ablation, 123 (31.9%) experienced recurrent atrial arrhythmias over one-year follow-up. Recurrent arrhythmias (failed ablations) occurred at higher SRM stages with 28/133 (21.0%) stage I, 40/140 (29.3%) stage II, 24/71 (33.8%) stage III, and 30/42 (71.4%) stage IV. In multi-variate analysis, ablation outcome was best predicted by advanced SRM stage (hazard ratio (HR) 4.89; p<0.0001) and diabetes (HR 1.64; p=0.036) while increased LA volume and persistent AF were not significant predictors. LA wall enhancement was significantly greater in AF patients vs. non-AF controls (16.6±11.2% vs. 3.1±1.9%, p<0.0001). Histological evidence of remodeling from surgical biopsy specimens correlated with SRM on LGE-MRI. Atrial SRM is identified on LGE-MRI and extensive LGE (≥30% LA wall enhancement) predicts poor response to catheter ablation therapy for AF.