MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study
MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study
复制标题
DOI：
10.1111/jce.12650
复制
发表时间：
2015-05-01
影响因子：
2.7
通讯作者：
Marrouche, Nassir F.
中科院分区：
文献类型：
--
作者：
Akoum, Nazem;Wilber, David;Marrouche, Nassir F.
MRI评估心房颤动中消融诱导瘢痕形成背景对于导管消融导致的瘢痕形成的范围和位置及其在抑制心房颤动（AF）中的作用的认识有限。我们研究了心房纤维化和消融引起的疤痕对AF导管消融结局的影响。MethodsWe进行了一项前瞻性多中心研究，招募了329名AF患者进行导管消融。在消融前获得左心房的延迟增强磁共振成像（DE-MRI）。在消融后90天获得DE-MRI扫描的177例患者中评价了瘢痕。我们评价了残余纤维化，定义为消融前心房纤维化未被消融瘢痕覆盖。主要结果是从复发性房性心律失常freedom.ResultsIn分析队列的177例患者，消融前纤维化是18.7 - 8.7%的心房壁。163名患者（92.1%）进行了针对肺静脉（PV）隔离的消融。消融诱导的瘢痕平均占心房壁的10.6 ± 4.4%。仅12例患者（7.3%）的瘢痕完全包围所有4条肺静脉。残余纤维化计算值为15.8 ± 8.0%。在325天随访时，35%的患者出现复发性心律失常。多变量考克斯比例风险模型表明，基线心房纤维化（HR和95% CI）（1.09 [1.06-1.12]，P < 0.001）和残余纤维化（1.09 [1.05-1.13]，P < 0.001）与房性心律失常复发有关，而肺静脉周围和整体瘢痕则没有。结论针对肺静脉的房颤导管消融很少在预期区域实现永久性环绕瘢痕。基线时存在的总体心房纤维化和消融瘢痕未覆盖的残余纤维化与复发性心律失常相关。
MRI Assessment of Ablation-Induced Scarring in Atrial FibrillationBackgroundThere is limited knowledge on the extent and location of scarring that results from catheter ablation and its role in suppressing atrial fibrillation (AF). We examined the effect of atrial fibrosis and ablation-induced scarring on catheter ablation outcomes in AF.MethodsWe conducted a prospective multicenter study that enrolled 329 AF patients presenting for catheter ablation. Delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium was obtained preablation. Scarring was evaluated in 177 patients with a DE-MRI scan obtained 90 days postablation. We evaluated residual fibrosis, defined as preablation atrial fibrosis not covered by ablation scar. The primary outcome was freedom from recurrent atrial arrhythmia.ResultsIn the analysis cohort of 177 patients, preablation fibrosis was 18.7 8.7% of the atrial wall. Ablation aimed at pulmonary vein (PV) isolation was performed in 163 patients (92.1%). Ablation-induced scar averaged 10.6 +/- 4.4% of the atrial wall. Scarring completely encircled all 4 PVs only in 12 patients (7.3%). Residual fibrosis was calculated at 15.8 +/- 8.0%. At 325 days follow-up, 35% of patients experienced recurrent arrhythmia. Multivariable Cox proportional hazards models demonstrated that baseline atrial fibrosis (HR and 95% CIs) (1.09 [1.06-1.12], P < 0.001) and residual fibrosis (1.09 [1.05-1.13], P < 0.001) were associated with atrial arrhythmia recurrence, while PV encirclement and overall scar were not.ConclusionsCatheter ablation of AF targeting PVs rarely achieves permanent encircling scar in the intended areas. Overall atrial fibrosis present at baseline and residual fibrosis uncovered by ablation scar are associated with recurrent arrhythmia.