Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF

Irfan M. Khurram, Mohammadali Habibi, Esra Gucuk Ipek, Jonathan Chrispin, Eunice Yang, Kotaro Fukumoto, Jane Dewire, David D Spragg, Joseph Marine, Ronald D Berger, Hiroshi Ashikaga, Jack Rickard, Yiyi Zhang, Vadim Zipunnikov, Stefan Zimmerman, Hugh Calkins, Saman Nazarian

Research output: Contribution to journalArticle

Abstract

Objectives: The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence. Background: Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial LGE on cardiac magnetic resonance. Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE. Methods: The cohort included 165 participants (mean age 60.0 ± 10.2 years, 77% men, 57% with persistent AF) who underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazards models. Multiplicative and additive interactions between AF type and LGE extent were examined. Results: During 10.2 ± 5.7 months of follow-up, 63 patients (38.2%) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10% increased LGE; p <0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction. Conclusions: Regardless of AF persistence at baseline, participants with LGE ≤35% have favorable outcomes, whereas those with LGE >35% have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for: 1) patient selection for AF ablation using LGE extent; and 2) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35% of left atrial myocardium.

Original languageEnglish (US)
JournalJACC: Cardiovascular Imaging
DOIs
StateAccepted/In press - May 27 2015

Fingerprint

Pulmonary Veins
Gadolinium
Atrial Fibrillation
Cardiac Arrhythmias
Recurrence
Patient Isolation
Catheter Ablation
Proportional Hazards Models
Patient Selection
Myocardium

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Late gadolinium enhancement
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF. / Khurram, Irfan M.; Habibi, Mohammadali; Gucuk Ipek, Esra; Chrispin, Jonathan; Yang, Eunice; Fukumoto, Kotaro; Dewire, Jane; Spragg, David D; Marine, Joseph; Berger, Ronald D; Ashikaga, Hiroshi; Rickard, Jack; Zhang, Yiyi; Zipunnikov, Vadim; Zimmerman, Stefan; Calkins, Hugh; Nazarian, Saman.

In: JACC: Cardiovascular Imaging, 27.05.2015.

Research output: Contribution to journalArticle

@article{0e6788b3782a4639b9170f8a808b615a,
title = "Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF",
abstract = "Objectives: The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence. Background: Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial LGE on cardiac magnetic resonance. Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE. Methods: The cohort included 165 participants (mean age 60.0 ± 10.2 years, 77{\%} men, 57{\%} with persistent AF) who underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazards models. Multiplicative and additive interactions between AF type and LGE extent were examined. Results: During 10.2 ± 5.7 months of follow-up, 63 patients (38.2{\%}) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10{\%} increased LGE; p <0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35{\%} and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction. Conclusions: Regardless of AF persistence at baseline, participants with LGE ≤35{\%} have favorable outcomes, whereas those with LGE >35{\%} have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for: 1) patient selection for AF ablation using LGE extent; and 2) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35{\%} of left atrial myocardium.",
keywords = "Atrial fibrillation, Catheter ablation, Late gadolinium enhancement, Magnetic resonance imaging",
author = "Khurram, {Irfan M.} and Mohammadali Habibi and {Gucuk Ipek}, Esra and Jonathan Chrispin and Eunice Yang and Kotaro Fukumoto and Jane Dewire and Spragg, {David D} and Joseph Marine and Berger, {Ronald D} and Hiroshi Ashikaga and Jack Rickard and Yiyi Zhang and Vadim Zipunnikov and Stefan Zimmerman and Hugh Calkins and Saman Nazarian",
year = "2015",
month = "5",
day = "27",
doi = "10.1016/j.jcmg.2015.10.015",
language = "English (US)",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF

AU - Khurram, Irfan M.

AU - Habibi, Mohammadali

AU - Gucuk Ipek, Esra

AU - Chrispin, Jonathan

AU - Yang, Eunice

AU - Fukumoto, Kotaro

AU - Dewire, Jane

AU - Spragg, David D

AU - Marine, Joseph

AU - Berger, Ronald D

AU - Ashikaga, Hiroshi

AU - Rickard, Jack

AU - Zhang, Yiyi

AU - Zipunnikov, Vadim

AU - Zimmerman, Stefan

AU - Calkins, Hugh

AU - Nazarian, Saman

PY - 2015/5/27

Y1 - 2015/5/27

N2 - Objectives: The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence. Background: Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial LGE on cardiac magnetic resonance. Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE. Methods: The cohort included 165 participants (mean age 60.0 ± 10.2 years, 77% men, 57% with persistent AF) who underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazards models. Multiplicative and additive interactions between AF type and LGE extent were examined. Results: During 10.2 ± 5.7 months of follow-up, 63 patients (38.2%) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10% increased LGE; p <0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction. Conclusions: Regardless of AF persistence at baseline, participants with LGE ≤35% have favorable outcomes, whereas those with LGE >35% have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for: 1) patient selection for AF ablation using LGE extent; and 2) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35% of left atrial myocardium.

AB - Objectives: The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence. Background: Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial LGE on cardiac magnetic resonance. Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE. Methods: The cohort included 165 participants (mean age 60.0 ± 10.2 years, 77% men, 57% with persistent AF) who underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazards models. Multiplicative and additive interactions between AF type and LGE extent were examined. Results: During 10.2 ± 5.7 months of follow-up, 63 patients (38.2%) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10% increased LGE; p <0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction. Conclusions: Regardless of AF persistence at baseline, participants with LGE ≤35% have favorable outcomes, whereas those with LGE >35% have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for: 1) patient selection for AF ablation using LGE extent; and 2) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35% of left atrial myocardium.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Late gadolinium enhancement

KW - Magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=84953241756&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953241756&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2015.10.015

DO - 10.1016/j.jcmg.2015.10.015

M3 - Article

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

ER -