Incidental LV LGE on CMR Imaging in Atrial Fibrillation Predicts Recurrence After Ablation Therapy

JACC Cardiovasc Imaging. 2015 Jul;8(7):793-800. doi: 10.1016/j.jcmg.2015.03.008. Epub 2015 Jun 17.

Abstract

Objectives: This study sought to evaluate the prognostic significance of left ventricular late gadolinium enhancement (LV-LGE) incidentally found in atrial fibrillation (AF) patients who undergo ablation therapy.

Background: LV-LGE provides prognostic information in patients with ischemic and nonischemic cardiomyopathies. However, data on the clinical significance of incidental LV-LGE in the AF population are limited.

Methods: A total of 778 patients who were referred for radiofrequency ablation of AF underwent cardiac magnetic resonance examinations between June 2006 and January 2013. Patients with a history of myocardial infarction or ablation therapy were excluded. The presence of LV-LGE was assessed by experienced imaging physicians. Patients were followed for arrhythmia recurrence after the radiofrequency ablation procedure.

Results: Of 598 patients included in the study, 60% were men with a mean age of 64 years and a median AF duration of 25 months. LV-LGE was detected in 39 patients (6.5%). There were 240 arrhythmia recurrences observed involving 40% of patients over a median follow-up period of 52 months. On univariate analysis, age (hazard ratio [HR]: 1.02; 95% confidence interval [CI]: 1.00 to 1.03), male sex (HR: 0.63; 95% CI: 0.47 to 0.86), diabetes (HR: 1.53; 95% CI: 1.03 to 2.27), CHADS2 score (HR: 1.19; 95% CI: 1.04 to 1.36), CHA2DS2-VASc score (HR: 1.18; 95% CI: 1.08 to 1.30), left atrial (LA) fibrosis (HR: 1.66; 95% CI: 1.41 to 1.96), LV-LGE (HR: 1.83; 95% CI: 1.11 to 3.03), persistent AF (HR: 1.52; 95% CI: 1.11 to 2.09), and LA area (HR: 1.03; 95% CI: 1.01 to 1.05) were significantly associated with arrhythmia recurrence. The recurrence rate was 69% in patients with LV-LGE compared with 38% in patients without LV-LGE (p < 0.001). In a multivariate model, LA fibrosis and LV-LGE were independent predictors of arrhythmia recurrence.

Conclusions: In AF patients without history of myocardial infarction, LV-LGE is a significant independent predictor of arrhythmia recurrence after ablation therapy.

Keywords: ablation therapy; atrial fibrillation; cardiac magnetic resonance; late gadolinium enhancement.

MeSH terms

  • Aged
  • Atrial Fibrillation / pathology
  • Atrial Fibrillation / surgery*
  • Catheter Ablation*
  • Female
  • Forecasting
  • Gadolinium
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Prognosis
  • Recurrence
  • Ventricular Function / physiology*

Substances

  • Gadolinium