Substrate Modification Is a Better Predictor of Catheter Ablation Success in Atrial Fibrillation Than Pulmonary Vein Isolation: An LGE-MRI Study.
Substrate Modification Is a Better Predictor of Catheter Ablation Success in Atrial Fibrillation Than Pulmonary Vein Isolation: An LGE-MRI Study.
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DOI：
10.4137/cmc.s22100
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发表时间：
2015
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影响因子：
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通讯作者：
Marrouche N
中科院分区：
文献类型：
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作者：
Akoum N;Morris A;Perry D;Cates J;Burgon N;Kholmovski E;MacLeod R;Marrouche N
心房颤动(房颤)的导管消融结果差异很大。我们使用晚期Gd增强MRI(LGE-MRI)检查消融引起的肺静脉(PV)区域和整个心房瘢痕形成的关系，以评估PV环绕和基质修改在预测房颤导管消融结果中的作用。基础房纤维化分为4期(I期纤维化10%，II期纤维化10~20%，III期纤维化20~30%，IV期纤维化≥30%)。然后，患者接受消融，并在三个月后重复LGE-MRI，以评估消融诱导的瘢痕形成。对PVS进行检查，以评估伴瘢痕的完全性环绕。图像处理被用来将瘢痕覆盖在基线纤维化上，以评估重叠并计算残余纤维化。共纳入172例患者，平均基线纤维化程度为14.6±8.4%。术后3个月有瘢痕的静脉曲张平均为1.2±1.3个，完全包绕4个静脉曲张的仅占9%。平均残余纤维化11.9±7.3%。高残留纤维化定义为>；10%。随访346±82天，60例(34.9%)房颤复发。基线和高残留纤维化是复发的显著预测因素(风险比分别为2.2；P<；0.01；HR为3.2；P<；0.01)。包绕的PV数目并不是复发的重要预测因素。消融性瘢痕形成的LGE-MRI显示慢性肺静脉环绕症很少发生。基线心房纤维化和消融诱导的基质改变能更好地预测手术结果。
Outcomes of catheter ablation of atrial fibrillation (AF) vary widely. We used late-gadolinium enhancement MRI (LGE-MRI) to examine the relationship of ablation-induced scarring in the pulmonary vein (PV) region and overall atrium to evaluate the role of PV encirclement and substrate modification in predicting outcome of catheter ablation in AF. LGE-MRI was performed to quantify baseline atrial fibrosis, which was classified into four stages (stage I with fibrosis <10%, stage II with fibrosis 10–20%, stage III with fibrosis 20–30%, and stage IV with fibrosis ≥30%). Patients then underwent ablation and repeat LGE-MRI at three months to assess for ablation-induced scarring. PVs were studied to evaluate for complete encirclement with scar. Image processing was used to overlay the scar onto baseline fibrosis to assess the overlap and calculate residual fibrosis. A total of 172 patients were included with an average baseline fibrosis of 14.6 ± 8.4%. The average number of PVs encircled with scar at three months was 1.2 ± 1.3 with only 9% of patients having all four PVs completely encircled. The average residual fibrosis was 11.9 ± 7.3%. High residual fibrosis was defined as >10%. Recurrent AF was found in 60 patients (34.9%) over a follow-up of 346 ± 82 days. Baseline and high residual fibrosis were significant predictors of recurrence (hazard ratio [HR] of 2.2; P < 0.01 and HR of 3.2; P < 0.01, respectively). The number of PV encircled was not a significant predictor of recurrence. LGE-MRI of ablation-induced scarring demonstrates that chronic PV encirclement is rarely achieved. Procedural outcomes are better predicted by baseline atrial fibrosis and ablation-induced substrate modification.