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J Interv Card Electrophysiol. 2015 Dec;44(3):247-56. doi: 10.1007/s10840-015-0060-y. Epub 2015 Oct 12.

Poor scar formation after ablation is associated with atrial fibrillation recurrence.

Author information

1
CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA.
2
Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
3
CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA. ravi.ranjan@hsc.utah.edu.

Abstract

PURPOSE:

Patients routinely undergo ablation for atrial fibrillation (AF) but the recurrence rate remains high. We explored in this study whether poor scar formation as seen on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) correlates with AF recurrence following ablation.

METHODS:

We retrospectively identified 94 consecutive patients who underwent their initial ablation for AF at our institution and had pre-procedural magnetic resonance angiography (MRA) merged with left atrial (LA) anatomy in an electroanatomic mapping (EAM) system, ablated areas marked intraprocedurally in EAM, 3-month post-ablation LGE-MRI for assessment of scar, and minimum of 3-months of clinical follow-up. Ablated area was quantified retrospectively in EAM and scarred area was quantified in the 3-month post-ablation LGE-MRI.

RESULTS:

With the mean follow-up of 336 days, 26 out of 94 patients had AF recurrence. Age, hypertension, and heart failure were not associated with AF recurrence, but LA size and difference between EAM ablated area and LGE-MRI scar area was associated with higher AF recurrence. For each percent higher difference between EAM ablated area and LGE-MRI scar area, there was a 7-9% higher AF recurrence (p values 0.001-0.003) depending on the multivariate analysis.

CONCLUSIONS:

In AF ablation, poor scar formation as seen on LGE-MRI was associated with AF recurrence. Improved mapping and ablation techniques are necessary to achieve the desired LA scar and reduce AF recurrence.

KEYWORDS:

Ablation; Atrial fibrillation; MRI; Poor scar formation; Recurrence

PMID:
26455362
PMCID:
PMC4728137
DOI:
10.1007/s10840-015-0060-y
[Indexed for MEDLINE]
Free PMC Article

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