Delayed Gadolinium Enhancement Magnetic Resonance Imaging Detected Anatomic Gap Length in Wide Circumferential Pulmonary Vein Ablation Lesions Is Associated With Recurrence of Atrial Fibrillation
Delayed Gadolinium Enhancement Magnetic Resonance Imaging Detected Anatomic Gap Length in Wide Circumferential Pulmonary Vein Ablation Lesions Is Associated With Recurrence of Atrial Fibrillation
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DOI：
10.1161/circep.118.006659
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发表时间：
2018-12-01
影响因子：
8.4
通讯作者：
Mont, Lluis
中科院分区：
文献类型：
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作者：
Linhart, Markus;Alarcon, Francisco;Mont, Lluis
背景：通过延迟Gd增强心脏磁共振评价解剖间隙对第一肺静脉(PV)隔离后房颤(AF)复发的影响，目前知之甚少。方法：连续的患者在射频环状PV隔离3个月后接受延迟Gd增强心脏磁共振检查。对94例患者(52+/-11岁，62%为阵发性房颤)的2x8节段模型中产生2880个节段的360PV延迟Gd增强心脏磁共振图像进行了评估。使用专用软件对左心房进行分割。解剖间隙定义为消融线中断=3 mm。相对间隙长度的计算方法为绝对间隙长度除以消融线总长度。平均随访15+/-10个月后评估房颤复发。结果：平均每个患者解剖间隙数为5.4。21例阵发性房颤患者(36%)和19例持续性房颤患者(53%)在消融后1年内复发。在单因素分析中，CHA2DS2-VASC评分、房颤类型和相对间隙长度是复发的预测因素。在多变量分析中，只有相对间隙长度与房颤复发显著相关(风险比，每10%间隙中有1.16[1.02-1.31]个)。结论：在首次肺静脉隔离1年后，心脏磁共振与肺静脉消融线上的解剖间隙数目无关，而是总的相对间隙长度与房颤复发有关。相对间隙长度增加10%，房颤复发的可能性增加16%。
BACKGROUND: There is limited knowledge about the impact of anatomic gaps as assessed by delayed gadolinium enhancement cardiac magnetic resonance on atrial fibrillation (AF) recurrence after first pulmonary vein (PV) isolation.METHODS: Consecutive patients underwent delayed gadolinium enhancement cardiac magnetic resonance 3 months after radiofrequency circumferential PV isolation. Delayed gadolinium enhancement cardiac magnetic resonance images were assessed from 360 PV resulting in 2880 segments in the 2x8-segment model from 94 patients (52 +/- 11 years, 62% paroxysmal AF). Left atria were segmented using dedicated software. Anatomic gap was defined as discontinuation of the ablation line by = 3 mm. Relative gap length was calculated as absolute gap length divided by the total length of the ablation line. AF recurrence was assessed after a mean follow-up duration of 15 +/- 10 monthsRESULTS: Mean number of anatomic gaps was 5.4 per patient. Recurrence within the first year of ablation was observed in 21 patients with paroxysmal AF (36%) and 19 patients with persistent AF (53%). In the univariate analysis, CHA 2 DS 2 -VASc score, AF type, and relative gap length were predictive of recurrence. In the multivariate analysis, only relative gap length was significantly associated with recurrence (hazard ratio, 1.16 [1.02-1.31] per each 10% of gap).CONCLUSIONS: The total relative gap length but not the number of anatomic gaps in the PV ablation line as assessed by delayed gadolinium enhancement cardiac magnetic resonance was associated with AF recurrence 1 year after first PV isolation. An increase of 10% relative gap length increased the likelihood of AF recurrence by 16%.