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 E. Marine; Ronald D. Berger; Hiroshi Ashikaga; Jack Rickard; Yiyi Zhang; Vadim Zipunnikov; Stefan L. Zimmerman; Hugh Calkins; Saman Nazarian

doi:10.1016/j.jcmg.2015.10.015

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 E. Marine, Ronald D. Berger, Hiroshi Ashikaga, Jack Rickard, Yiyi Zhang, Vadim Zipunnikov, Stefan L. Zimmerman, Hugh Calkins, Saman Nazarian

Research output: Contribution to journal › Article › peer-review

65 Scopus citations

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 language	English (US)
Pages (from-to)	142-148
Number of pages	7
Journal	JACC: Cardiovascular Imaging
Volume	9
Issue number	2
DOIs	https://doi.org/10.1016/j.jcmg.2015.10.015
State	Published - Feb 1 2016

Keywords

atrial fibrillation
catheter ablation
late gadolinium enhancement
magnetic resonance imaging

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jcmg.2015.10.015

Cite this

Khurram, I. M., Habibi, M., Gucuk Ipek, E., Chrispin, J., Yang, E., Fukumoto, K., Dewire, J., Spragg, D. D., Marine, J. E., Berger, R. D., Ashikaga, H., Rickard, J., Zhang, Y., Zipunnikov, V., Zimmerman, S. L., Calkins, H., & Nazarian, S. (2016). Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF. JACC: Cardiovascular Imaging, 9(2), 142-148. https://doi.org/10.1016/j.jcmg.2015.10.015

Khurram, IM, Habibi, M, Gucuk Ipek, E, Chrispin, J, Yang, E, Fukumoto, K, Dewire, J, Spragg, DD , Marine, JE , Berger, RD, Ashikaga, H, Rickard, J, Zhang, Y, Zipunnikov, V , Zimmerman, SL , Calkins, H & Nazarian, S 2016, 'Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF', JACC: Cardiovascular Imaging, vol. 9, no. 2, pp. 142-148. https://doi.org/10.1016/j.jcmg.2015.10.015

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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 Marine, {Joseph E.} and Berger, {Ronald D.} and Hiroshi Ashikaga and Jack Rickard and Yiyi Zhang and Vadim Zipunnikov and Zimmerman, {Stefan L.} and Hugh Calkins and Saman Nazarian",

note = "Publisher Copyright: {\textcopyright} 2016 American College of Cardiology Foundation",

year = "2016",

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day = "1",

doi = "10.1016/j.jcmg.2015.10.015",

language = "English (US)",

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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 E.

AU - Berger, Ronald D.

AU - Ashikaga, Hiroshi

AU - Rickard, Jack

AU - Zhang, Yiyi

AU - Zipunnikov, Vadim

AU - Zimmerman, Stefan L.

AU - Calkins, Hugh

AU - Nazarian, Saman

PY - 2016/2/1

Y1 - 2016/2/1

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

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