Relationship Between Fibrosis Detected on Late Gadolinium-Enhanced Cardiac Magnetic Resonance and Re-Entrant Activity Assessed With Electrocardiographic Imaging in Human Persistent Atrial Fibrillation
OBJECTIVES: This study sought to assess the relationship between fibrosis and re-entrant activity in persistent atrial fibrillation (AF).
BACKGROUND: The mechanisms involved in sustaining re-entrant activity during AF are poorly understood.
METHODS: Forty-one patients with persistent AF (age 56 ± 12 years; 6 women) were evaluated. High-resolution electrocardiographic imaging (ECGI) was performed during AF by using a 252-chest electrode array, and phase mapping was applied to locate re-entrant activity. Sites of high re-entrant activity were defined as re-entrant regions. Late gadolinium-enhanced (LGE) cardiac magnetic resonance (CMR) was performed at 1.25 × 1.25 × 2.5 mm resolution to characterize atrial fibrosis and measure atrial volumes. The relationship between LGE burden and the number of re-entrant regions was analyzed. Local LGE density was computed and characterized at re-entrant sites. All patients underwent catheter ablation targeting re-entrant regions, the procedural endpoint being AF termination. Clinical, CMR, and ECGI predictors of acute procedural success were then analyzed.
RESULTS: Left atrial (LA) LGE burden was 22.1 ± 5.9% of the wall, and LA volume was 74 ± 21 ml/m2. The number of re-entrant regions was 4.3 ± 1.7 per patient. LA LGE imaging was significantly associated with the number of re-entrant regions (R = 0.52, p = 0.001), LA volume (R = 0.62, p < 0.0001), and AF duration (R = 0.54, p = 0.0007). Regional analysis demonstrated a clustering of re-entrant activity at LGE borders. Areas with high re-entrant activity showed higher local LGE density as compared with the remaining atrial areas (p < 0.0001). Failure to achieve AF termination during ablation was associated with higher LA LGE burden (p < 0.001), higher number of re-entrant regions (p < 0.001), and longer AF duration (p = 0.008).
CONCLUSIONS: The number of re-entrant regions during AF relates to the extent of LGE on CMR, with the location of these regions clustering to LGE areas. These characteristics affect procedural outcomes of ablation.
| Errataetall: |
CommentIn: JACC Clin Electrophysiol. 2018 Jan;4(1):30-32. - PMID 29600783 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:4 |
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| Enthalten in: |
JACC. Clinical electrophysiology - 4(2018), 1 vom: 13. Jan., Seite 17-29 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cochet, Hubert [VerfasserIn] |
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| Links: |
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| Themen: |
AU0V1LM3JT |
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| Anmerkungen: |
Date Completed 08.10.2019 Date Revised 10.04.2022 published: Print-Electronic CommentIn: JACC Clin Electrophysiol. 2018 Jan;4(1):30-32. - PMID 29600783 Citation Status MEDLINE |
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| doi: |
10.1016/j.jacep.2017.07.019 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM28137659X |
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| 100 | 1 | |a Cochet, Hubert |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Relationship Between Fibrosis Detected on Late Gadolinium-Enhanced Cardiac Magnetic Resonance and Re-Entrant Activity Assessed With Electrocardiographic Imaging in Human Persistent Atrial Fibrillation |
| 264 | 1 | |c 2018 | |
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| 500 | |a Date Completed 08.10.2019 | ||
| 500 | |a Date Revised 10.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: JACC Clin Electrophysiol. 2018 Jan;4(1):30-32. - PMID 29600783 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: This study sought to assess the relationship between fibrosis and re-entrant activity in persistent atrial fibrillation (AF) | ||
| 520 | |a BACKGROUND: The mechanisms involved in sustaining re-entrant activity during AF are poorly understood | ||
| 520 | |a METHODS: Forty-one patients with persistent AF (age 56 ± 12 years; 6 women) were evaluated. High-resolution electrocardiographic imaging (ECGI) was performed during AF by using a 252-chest electrode array, and phase mapping was applied to locate re-entrant activity. Sites of high re-entrant activity were defined as re-entrant regions. Late gadolinium-enhanced (LGE) cardiac magnetic resonance (CMR) was performed at 1.25 × 1.25 × 2.5 mm resolution to characterize atrial fibrosis and measure atrial volumes. The relationship between LGE burden and the number of re-entrant regions was analyzed. Local LGE density was computed and characterized at re-entrant sites. All patients underwent catheter ablation targeting re-entrant regions, the procedural endpoint being AF termination. Clinical, CMR, and ECGI predictors of acute procedural success were then analyzed | ||
| 520 | |a RESULTS: Left atrial (LA) LGE burden was 22.1 ± 5.9% of the wall, and LA volume was 74 ± 21 ml/m2. The number of re-entrant regions was 4.3 ± 1.7 per patient. LA LGE imaging was significantly associated with the number of re-entrant regions (R = 0.52, p = 0.001), LA volume (R = 0.62, p < 0.0001), and AF duration (R = 0.54, p = 0.0007). Regional analysis demonstrated a clustering of re-entrant activity at LGE borders. Areas with high re-entrant activity showed higher local LGE density as compared with the remaining atrial areas (p < 0.0001). Failure to achieve AF termination during ablation was associated with higher LA LGE burden (p < 0.001), higher number of re-entrant regions (p < 0.001), and longer AF duration (p = 0.008) | ||
| 520 | |a CONCLUSIONS: The number of re-entrant regions during AF relates to the extent of LGE on CMR, with the location of these regions clustering to LGE areas. These characteristics affect procedural outcomes of ablation | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a atrial fibrillation | |
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| 700 | 1 | |a Al Jefairi, Nora |e verfasserin |4 aut | |
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