The DOI matches its Crossref record; 49 of the 49 references it cites were found in a registry or an index.
Atrial Fibrillation Ablation Outcome Is Predicted by Left Atrial Remodeling on MRI
Open accessAbstract
Background—: Although catheter ablation therapy for atrial fibrillation (AF) is becoming more common, results vary widely, and patient selection criteria remain poorly defined. We hypothesized that late gadolinium enhancement MRI (LGE-MRI) can identify left atrial (LA) wall structural remodeling (SRM) and stratify patients who are likely or not to benefit from ablation therapy. Methods and Results—: LGE-MRI was performed on 426 consecutive patients with AF without contraindications to MRI before undergoing their first ablation procedure and on 21 non-AF control subjects. Patients were categorized by SRM stage (I–IV) based on the percentage of LA wall enhancement for correlation with procedure outcomes. Histological validation of SRM was performed comparing LGE-MRI with surgical biopsy. A total of 386 patients (91%) with adequate LGE-MRI scans were included in the study. After ablation, 123 patients (31.9%) experienced recurrent atrial arrhythmias during the 1-year follow-up. Recurrent arrhythmias (failed ablations) occurred at higher SRM stages with 28 of 133 (21.0%) in stage I, 40 of 140 (29.3%) in stage II, 24 of 71 (33.8%) in stage III, and 30 of 42 (71.4%) in stage IV. In multivariate analysis, ablation outcome was best predicted by advanced SRM stage (hazard ratio, 4.89; P <0.0001) and diabetes mellitus (hazard ratio, 1.64; P =0.036), whereas increased LA volume and persistent AF were not significant predictors. LA wall enhancement was significantly greater in patients with AF versus non-AF controls (16.6±11.2% versus 3.1±1.9%; P <0.0001). Histological evidence of remodeling from surgical biopsy specimens correlated with SRM on LGE-MRI. Conclusions—: Atrial SRM is identified on LGE-MRI, and extensive LGE (≥30% LA wall enhancement) predicts poor response to catheter ablation therapy for AF.
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Cites
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Cited by
Calkins, H., Hindricks, G., Cappato, R., Kim, Y.-H., Saad, E. B., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, J., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.05.012 · Cited by 2,755
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Computationally guided personalized targeted ablation of persistent atrial fibrillation
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Nielsen, J. C., Lin, Y.-J., de Oliveira Figueiredo, M. J., Sepehri Shamloo, A., Alfie, A., Boveda, S., Dagres, N., Di Toro, D., Eckhardt, L. L., Ellenbogen, K., et al. (2020) · EP Europace · doi:10.1093/europace/euaa065 · Cited by 98
Metadata
- Authors
- McGann, C., Akoum, N., Patel, A., Kholmovski, E., Revelo, P., Damal, K., Wilson, B., Cates, J., Harrison, A., Ranjan, R., Burgon, N. S., Greene, T., Kim, D., DiBella, E. V. R., Parker, D., MacLeod, R. S., & Marrouche, N. F.
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2014-02
- Volume
- 7
- Issue
- 1
- Pages
- 23-30
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2165762489
- Cited by
- 417
- References
- 49
- FWCI
- 18.22
- Type
- journal article
- Language
- en
- Open access
- bronze
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- McGann, C., Akoum, N., Patel, A., Kholmovski, E., Revelo, P., Damal, K., Wilson, B., Cates, J., Harrison, A., Ranjan, R., Burgon, N. S., Greene, T., Kim, D., DiBella, E. V. R., Parker, D., MacLeod, R. S., & Marrouche, N. F. (2014). Atrial Fibrillation Ablation Outcome Is Predicted by Left Atrial Remodeling on MRI. Circulation: Arrhythmia and Electrophysiology. https://doi.org/10.1161/circep.113.000689
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