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Arrhythmias and sudden death
Original research article
Low incidence of left atrial delayed enhancement with MRI in patients with AF: a single-centre experience
  1. John P Bois1,
  2. James Glockner2,
  3. Phillip M Young2,
  4. Thomas A Foley1,2,
  5. Seth Sheldon1,
  6. Darrell B Newman1,
  7. Grace Lin1,
  8. Douglas L Packer1 and
  9. Peter A Brady1
  1. 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr John P Bois; bois.john{at}mayo.edu

Abstract

Background Atrial fibrillation (AF) is the most common sustained atrial arrhythmia. One potential target for ablation is left atrial (LA) scar (LAS) regions that may be the substrate for re-entry within the atria, thereby sustaining AF. Identification of LAS through LA delayed gadolinium enhancement (LADE) with MRI has been proposed.

Objectives We sought to evaluate LADE in patients referred for catheter ablation of AF.

Methods Prospective analysis was conducted of consecutive patients who underwent pulmonary vein antrum isolation (PVAI) ablation for AF at a single institution. Patients underwent LADE with MRI to determine LAS regions before ablation. MRI data were analysed independently in accordance with prespecified institutional protocol by two staff cardiac radiologists to whom patient outcomes were masked, and reports of LADE were documented. Where no initial consensus occurred regarding delayed enhancement (DE), a third staff cardiac radiologist independently reviewed the case and had the deciding vote.

Results Of the 149 consecutive patients (mean (SD) age, 59 (9) years), AF was persistent in 64 (43%) and paroxysmal in 85 (57%); 45 (30%) had prior ablation. Only five patients (3%) had identifiable DE in LA walls (persistent AF, n=1; paroxysmal AF, n=4). LADE was present in two (4%) of the 45 patients with previous left PVAI. The presence of LADE was not associated with a higher recurrence rate of AF.

Conclusions In contrast to previous studies, the finding of DE within LA walls was uncommon and, when present, did not correlate with AF type or risk of AF recurrence. It therefore is of unclear clinical significance.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000546

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    Footnotes

    • Contributors JPB, SS and DBN were responsible for data gathering. JG, PMY and TAF are responsible for LADE detection. PAB and JPB were responsible for study design. DLP and GL were responsible for review of the study and input on revisions. All authors were responsible for manuscript development.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval This study was approved by Mayo Clinic Institutional Review Board and was compliant with the Health Insurance Portability and Accountability Act.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.