Atrial Structure and Function 5 Years After Successful Ablation for Persistent Atrial Fibrillation: An MRI Study

被引:51
作者
Cochet, Hubert [1 ,2 ]
Scherr, Daniel [3 ,4 ]
Zellerhoff, Stephan [2 ,3 ]
Sacher, Frederic [2 ,3 ]
Derval, Nicolas [2 ,3 ]
Denis, Arnaud [2 ,3 ]
Knecht, Sebastien [2 ,3 ]
Komatsu, Yuki [2 ,3 ]
Montaudon, Michel [1 ,2 ]
Laurent, Francois [1 ,2 ]
Pieske, Burkert M. [4 ]
Hocini, Meleze [2 ,3 ]
Haissaguerre, Michel [2 ,3 ]
Jais, Pierre [2 ,3 ]
机构
[1] Univ Bordeaux, Dept Cardiovasc Imaging, CHU, Pessac, France
[2] Univ Bordeaux, LInst Rythmol & Modelisat Cardiaque LIRYC, CHU, INSERM,U1045, Pessac, France
[3] Univ Bordeaux, CHU, Dept Cardiac Pacing & Elect, Pessac, France
[4] Med Univ Graz, Dept Med, Div Cardiol, Graz, Austria
关键词
atrial fibrillation; atrial remodeling; catheter ablation; magnetic resonance imaging; RADIOFREQUENCY CATHETER ABLATION; PULMONARY-VEIN ISOLATION; RANDOMIZED-TRIAL; VOLUMES; SCAR; ECHOCARDIOGRAPHY; QUANTIFICATION;
D O I
10.1111/jce.12449
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Atrial Function After Persistent AF Ablation. Introduction: The atrial outcome after extensive ablation is unknown. We sought to quantify atrial structure and function years after successful ablation for persistent atrial fibrillation (PsAF). Methods and Results: We studied after 80 +/- 15 months 26 patients (54 +/- 8 years, 1 woman) with PsAF successfully treated by ablation (2.2 +/- 0.7 stepwise approach procedures, cumulative RF duration 126 +/- 37 minutes). At follow-up atrial scar burden and atrial outflows were quantified using delayed-enhanced and velocity-encoded MRI, respectively. Cine imaging was used to quantify atrial conduit function (CF), active emptying fraction (AEF), expansion index (EI), and the inter-appendage mechanical activation delay. Patients underwent exercise testing at baseline and follow-up. LA and RA scar extent were 29 +/- 6 and 4.3 +/- 2.8%, respectively. LA and RA AEF were 10.0 +/- 5.3 and 30 +/- 8%. Mean inter-appendage delay was 83 +/- 47 ms [42-217]. Complete LAA isolation was found in 3 patients. A wave was absent in 9/26 patients. LA scar extent related to the number of procedures (R = 0.58, P = 0.002) and total RF duration (R = 0.56, P = 0.003). Among follow-up characteristics, LA scar extent related to LAAEF (R = -0.73, P < 0.0001), LAEI (R = -0.64, P = 0.0003), A-wave peak (R = -0.72, P < 0.0001), and inter-appendage mechanical delay (R = 0.47, P = 0.02). At multivariable analysis, LA scar extent was independently related to LAAEF and LAEI. LAAEF and LA scar extent correlated with exercise capacity at follow-up (R = 0.44, P = 0.02, and R = -0.40; P = 0.04). Conclusion: LA contractility and compliance are markedly impaired years after successful PsAF ablation. LA dysfunction is closely related to scar burden.
引用
收藏
页码:671 / 679
页数:9
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