Prognostic role of left atrial fibrosis assessment using magnetic resonance imaging in patients with atrial fibrillation after catheter pulmonary vein isolation

Authors: Abgaryan A.A., Berdibekov B.Sh., Aleksandrova S.A., Ivanova Z.Z., Bulaeva N.I., Tarasova K.A., Dzhidzalova D.Kh., Romanchuk D.V., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-1-92-103

For citation: Abgaryan A.A., Berdibekov B.Sh., Aleksandrova S.A., Ivanova Z.Z., Bulaeva N.I., Tarasova K.A., Dzhidzalova D.Kh., Romanchuk D.V., Golukhova E.Z. Prognostic role of left atrial fibrosis assessment using magnetic resonance imaging in patients with atrial fibrillation after catheter pulmonary vein isolation. Creative Cardiology. 2024; 18 (1): 92–103 (in Russ.). DOI: 10.24022/1997-3187-2024-18-1-92-103

Received / Accepted:  19.01.2024 / 05.03.2024

Keywords: atrial fibrillation left atrial fibrosis pulmonary vein isolation magnetic resonance imaging



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Abstract

Objective. To investigate the relationship between the grade of left atrial (LA) fibrosisand the risk of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI).

Material and methods. This retrospective study included 34 patients with AF after PVI. The mean age of the patients was 67.1±10.1 years, 17 (50%) patients were male. The primary endpoint of the study was the development of AF recurrence in the remote period after PVI. All patients underwent time-delayed contrast-enhanced MRI before PVI to assess the grade of LA fibrosis. Cox regression analysis was performed to identify predictors of AF recurrence.

Results. At a median follow-up of 12 [12–24] months, AF recurrence was reported in nine (26.5%) patients. In ROC curve analysis, the threshold value of the left atrial volume index (LAVI) for predicting recurrent AF was 70 ml/m² (area under the curve 0.823±0.076; 95% confidence interval (CI) 0.67–0.97), and 19.5% for the degree of LA fibrosis (area under the curve 0.843±0.086; 95% CI 0.67–1.00). In multivariate Cox regression analysis, indexed LA volume (hazard ratio (HR) 1.05; 95% CI 1.01–1.09; p=0.009) and the degree of LA myocardial fibrosis (HR 1.13; 95% CI 1.01–1.26; p=0.028) were independent predictors of recurrent AF.

Conclusion. The extent of LA fibrosis is an independent predictor of arrhythmia recurrence in patients with AF undergoing PVI.

References

  1. Lippi G., Sanchis-Gomar F., Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int. J. Stroke. 2021; 16: 217–221. DOI: 10.1177/1747493019897870
  2. Jarasunas J., Aidietis A., Aidietiene S. Left atrial strain – an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc. Ultrasound. 2018; 16 (1): 29. DOI: 10.1186/s12947-018-0147-6
  3. Li G., Yang J., Zhang D., Wang X., Han J., Guo X. Research progress of myocardial fibrosis and atrial fibrillation. Front. Cardiovasc. Med. 2022; 9. DOI: 10.3389/fcvm.2022.889706
  4. Bax J.J., Marsan N.A., Delgado V. Non-invasive imaging in atrial fibrillation: focus on prognosis and catheter ablation. Heart. 2015; 101: 94–100. DOI: 10.1136/heartjnl-2013-305150
  5. Deng H., Bai Y., Shantsila A., Fauchier L., Potpara T.S., Lip G.Y. Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review. Clin. Res. Cardiol. 2017; 106; 813–23. DOI: 10.1007/s00392-017-1123-0
  6. Pim G., Marrouche N.F. Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome. Eur. Heart J. 2017; 38 (1): 14–19. DOI: 10.1093/eurheartj/ehv514
  7. Allessie M., Ausma J., Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc. Res. 2002; 54 (2): 230–246. DOI: 10.1016/s0008-6363(02)00258-4
  8. Burstein B., Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J. Am. Coll. Cardiol. 2008; 51 (8): 802–809. DOI: 10.1016/j.jacc.2007.09.064
  9. Anyukhovsky E.P., Sosunov E.A., Plotnikov A., Gainullin R.Z., Jhang J.S., Marboe C.C., Rosen M.R. Cellular electrophysiologic properties of old canine atria provide a substrate for arrhythmogenesis. Cardiovasc. Res. 2002; 54: 462–469. DOI: 10.1016/s0008-6363(02)00271-7
  10. Ohtani K., Yutani C., Nagata S., Koretsune Y., Hori M., Kamada T. High prevalence of atrial fibrosis in patients with dilated cardiomyopathy. J. Am. Coll. Cardiol. 1995; 25 (5): 1162–1169. DOI: 10.1016/0735-1097(94)00529-y
  11. Bailey G.W., Braniff B.A., Hancock E.W., Cohn K.E. Relation of left atrial pathology to atrial fibrillation in mitral valvular disease. Ann. Intern. Med. 1968; 69 (1): 13–20. DOI: 10.7326/0003- 4819-69-1-13
  12. Sinno H., Derakhchan K., Libersan D., Merhi Y., Leung T.K., Nattel S. Atrial ischemia promotes atrial fibrillation in dogs. Circulation. 2003; 107: 1930–1936.
  13. Shin S.H., Park M.Y., Oh W.J., Hong S.J., Pak H., Song W. et al. Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation. J. Am. Soc. Echocardiogr. 2008; 21: 697–702. DOI: 0.1016/j.echo.2007.10.022
  14. Kainuma S., Masai T., Yoshitatsu M., Miyagawa S., Yamauchi T., Takeda K. et al. Advanced left-atrial fibrosis is associated with unsuccessful maze operation for valvular atrial fibrillation. Eur. J. Cardiothorac. Surg. 2011; 40 (1): 61–69. DOI: 10.1016/j.ejcts.2010.11.008
  15. Teh A.W., Kistler P.M., Lee G., Medi C., Heck P.M., Spence S.J. et al. Electroanatomic remodeling of the left atrium in paroxysmal and persistent atrial fibrillation patients without structural heart disease. J. Cardiovasc. Electrophysiol. 2012; 23: 232–238. DOI: 10.1111/j.1540-8167.2011.02178.x
  16. Sim I., Razeghi O., Solis Lemus J.A., Mukherjee R., O’hare D., O’neill L. et al. Atrial tissue characterisation using electroanatomic voltage mapping and cardiac magnetic resonance imaging. Europace. 2022; 24 (1): 259–260. DOI: 10.1093/europace/euac053.177
  17. Akoum N., Daccarett M., Mcgann C., Segerson N., Vergara G., Kuppahally S. et al. Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach. J. Cardiovasc. Electrophysiol. 2011; 22 (1): 16–22. DOI: 10.1111/j.1540-8167.2010.01876.x
  18. Marrouche N.F., Wilber D., Hindricks G., Jais P., Akoum N., Marchlinski F. et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014; 311 (5): 498–506. DOI: 10.1001/jama.2014.3
  19. Gizatulina T.P., Martyanova L.U., Pavlov A.V., Shirokov N.E., Kolunin G.V., Belonogov D.V. et al. Predictors of significant left atrial fibrosis in patients with nonvalvular atrial fibrillation. Cardiology. 2020; 60 (2): 47–53. DOI: 10.18087/cardio.2020.2.n850
  20. Rossi V.A., Krizanovic-Grgic I., Steffel J., Hofer D., Wolber T., Brunckhorst C.B. et al. Predictors of left atrial fibrosis in patients with atrial fibrillation referred for catheter ablation. Cardiol. J. 2022; 29 (3): 413–422. DOI: 10.5603/CJ.a2022.0012
  21. Golukhova E.Z., Bulaeva N.I., Alexandrova S.A., Saparbaev A.A., Abgaryan A.A., Berdibekov B.Sh. Quantification of epicardial adipose tissue by computed tomographic scanning as a prognostic criterion of atrial fibrillation recurrence after catheter ablation. Kardiologiia. 2023; 63 (8): 3–10 (in Russ.). DOI: 10.18087/cardio.2023.8.n2168
  22. Mollaeva D.D., Mashina T.V., Mrikaev D.V., Berdibekov B.Sh., Filatov A.G., Golukhova E.Z. Modern ultrasound techniques in the assessment of left atrium structural abnormalities in patients with atrial fibrillation. Creative Cardiology. 2021; 15 (2): 48–60 (in Russ.). DOI: 10.24022/1997-3187-2021-15-1-48-60
  23. Marrouche N.F., Wazni O., McGann C., Greene T., Dean M.J., Dagher L. et al. Effect of MRI-guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the DECAAF II randomized clinical trial. JAMA. 2022; 327 (23): 2296–2305. DOI: 10.1001/jama.2022.8831
  24. Bisbal F., Benito E., Teis A., Alarcón F., Sarrias A., Caixal G. et al. Magnetic resonance imaging-guided fibrosis ablation for the treatment of atrial fibrillation: the ALICIA trial. Circ. Arrhythm. Electrophysiol. 2020; 13 (11): e008707. DOI: 10.1161/CIRCEP.120.008707

About Authors

  • Anna A. Abgaryan, Postgraduate, Cardiologist; ORCID
  • Bektur Sh. Berdibekov, Junior Researcher, Cardiologist; ORCID
  • Svetlana A. Aleksandrova, Cand. Med. Sci., Senior Researcher; ORCID
  • Zalina Z. Ivanova, Radiologist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Associate Professor, Head of Department, Cardiologist; ORCID
  • Kseniya A. Tarasova, Postgraduate; ORCID
  • Diana Kh. Dzhidzalova, Cardiologist; ORCID
  • Denis V. Romanchuk, Postgraduate; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery