Ovid Technologies (Wolters Kluwer Health)

Circulation: Arrhythmia and Electrophysiology

, volume 12 , issue 8

Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post–Atrial Fibrillation Ablation Recurrent Arrhythmia

Franziska Fochler ^{1, 2}

Takanori Yamaguchi ^{1, 3}

Mobin Kheirkahan ¹

Eugene G. Kholmovski ^{1, 4}

Alan P. Morris ¹

Nassir Marrouche ¹

Hide authors affiliations Show authors affiliations: 4 affiliations

Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City (F.F., T.Y., M.K., E.G.K., A.K.M., N.F.M.). |

Clinic for Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt/Saale, Germany (F.F.). |

Department of Cardiovascular Medicine, Saga University, Japan (T.Y.). |

⁴

Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City (E.G.K.). |

Publication type: Journal Article

Publication date: 2019-08-19

Ovid Technologies (Wolters Kluwer Health)

Circulation: Arrhythmia and Electrophysiology

scimago Q1

wos Q1

SJR: 3.416

CiteScore: 12.3

Impact factor: 9.8

ISSN: 19413149, 19413084

DOI: 10.1161/CIRCEP.119.007174

Copy DOI

PubMed ID: 31422685

Cardiology and Cardiovascular Medicine

Physiology (medical)

Abstract

Background:

Macroreentrant atrial tachycardia (AT) accounts for 40% to 60% of recurrent atrial arrhythmias after atrial fibrillation (AF) ablation. To describe late gadolinium enhancement magnetic resonance imaging (LGE-MRI)–detected scar-based dechanneling as new ablation strategy to treat ATs after AF ablation.

Methods:

Data from 102 patients who underwent initial AF ablation and repeat ablation for recurrent atrial arrhythmia within 1-year follow-up were analyzed. All patients underwent LGE-MRI before initial and repeat ablation. Depending on the recurrent rhythm, patients with AF and AT recurrence were assigned to group 1 or 2, respectively. Group 1 underwent fibrosis homogenization as second procedure. Group 2 underwent LGE-MRI–detected scar-based dechanneling. Both groups underwent reisolation of pulmonary veins if necessary.

Results:

Forty-six patients (45%) presented with AF, and 56 patients (55%) presented with AT recurrence during follow-up after initial ablation. In the first 25 patients from group 2, the AT was electroanatomically mapped, and a critical isthmus was defined. It was found that those isthmi were located in the regions with nontransmural scarring detected by LGE-MRI. In the last 31 patients from group 2, an empirical LGE-MRI–based dechanneling was performed solely based on the LGE-MRI results. During 1-year follow-up after second ablation, 67% patients in group 1 and 64% patients in group 2 were free from recurrence (log-rank, P =1.000). In group 2, 64% in the electroanatomically guided and 65% in the LGE-MRI dechanneling group were free from recurrence (log-rank, P =0.900).

Conclusions:

Anatomic targeting of LGE-MRI–detected gaps and superficial atrial scar is feasible and effective to treat recurrent arrhythmias post-AF ablation. Homogenization of existing scar is the appropriate treatment for recurrent AF, whereas dechanneling of existing isthmi seems the right approach for patients recurring with AT.

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Fochler F. et al. Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post–Atrial Fibrillation Ablation Recurrent Arrhythmia // Circulation: Arrhythmia and Electrophysiology. 2019. Vol. 12. No. 8.

GOST all authors (up to 50) Copy

Fochler F., Yamaguchi T., Kheirkahan M., Kholmovski E. G., Morris A. P., Marrouche N. Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post–Atrial Fibrillation Ablation Recurrent Arrhythmia // Circulation: Arrhythmia and Electrophysiology. 2019. Vol. 12. No. 8.

RIS |

Cite this

RIS Copy

TY - JOUR

DO - 10.1161/CIRCEP.119.007174

UR - https://doi.org/10.1161/CIRCEP.119.007174

TI - Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post–Atrial Fibrillation Ablation Recurrent Arrhythmia

T2 - Circulation: Arrhythmia and Electrophysiology

AU - Fochler, Franziska

AU - Yamaguchi, Takanori

AU - Kheirkahan, Mobin

AU - Kholmovski, Eugene G.

AU - Morris, Alan P.

AU - Marrouche, Nassir

PY - 2019

DA - 2019/08/19

PB - Ovid Technologies (Wolters Kluwer Health)

IS - 8

VL - 12

PMID - 31422685

SN - 1941-3149

SN - 1941-3084

ER -

BibTex

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BibTex (up to 50 authors) Copy

@article{2019_Fochler,

author = {Franziska Fochler and Takanori Yamaguchi and Mobin Kheirkahan and Eugene G. Kholmovski and Alan P. Morris and Nassir Marrouche},

title = {Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post–Atrial Fibrillation Ablation Recurrent Arrhythmia},

journal = {Circulation: Arrhythmia and Electrophysiology},

year = {2019},

volume = {12},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

month = {aug},

url = {https://doi.org/10.1161/CIRCEP.119.007174},

number = {8},

doi = {10.1161/CIRCEP.119.007174}

}

Publisher

Ovid Technologies (Wolters Kluwer Health)

Journal

Circulation: Arrhythmia and Electrophysiology

scimago Q1

wos Q1

SJR

3.416

CiteScore

12.3

Impact factor

9.8

ISSN

19413149 (Print)

19413084 (Electronic)

Profiles

Eugene G Kholmovski