TY - JOUR
T1 - Relation between left atrial wall composition by late gadolinium enhancement and complex fractionated atrial electrograms in patients with persistent atrial fibrillation
T2 - influence of non-fibrotic substrate in the left atrium
AU - Hwang, Sung Ho
AU - Oh, Yu Whan
AU - Lee, Dae In
AU - Shim, Jaemin
AU - Park, Sang Weon
AU - Kim, Young Hoon
N1 - Publisher Copyright:
© 2015, Springer Science+Business Media Dordrecht.
PY - 2015/8/2
Y1 - 2015/8/2
N2 - The complex fractioned atrial electrogram (CFAE) has been considered as the catheter ablation target of left atrium (LA) under persistent atrial fibrillation (PeAF). We evaluated the relation between the LA wall composition by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) and the CFAE in patients with PeAF. Forty-three patients underwent LGE-CMR and CFAE mapping before catheter ablation for PeAF. The LA wall substrates were classified into three: the fibrotic, intermediate, and normal substrates by using two thresholds of 2 standard deviation (2-SD) and 6-SD above the mean signal from the normal myocardium. For each of 12 preselected LA wall regions, the composition ratios (CRs) of fibrotic, indeterminate, and normal substrates were calculated as a percentage to the volume of LA wall region, and compared depending on the CFAE, respectively. The CR of normal substrate was significantly greater at the LA wall region with CFAE (52 ± 38 % vs. 20 ± 28 %, P < 0.01) than without CFAE. In contrast, the LA wall region with CFAE showed significantly lower CRs of intermediate substrate (39 ± 34 % vs. 57 ± 31 %, P < 0.01) and fibrotic substrate (7 ± 17 % vs. 21 ± 24 %, P < 0.01) than did the LA wall region without CFAE, respectively. Thus, the high CR (>18 %) of normal substrate predicted the CFAE at the corresponding LA wall region with 71 % sensitivity and 62 % specificity. In conclusion, the evaluation of LA wall normal substrate by LGE-CMR might be useful to predict the CFAE occurrence before catheter ablation of PeAF.
AB - The complex fractioned atrial electrogram (CFAE) has been considered as the catheter ablation target of left atrium (LA) under persistent atrial fibrillation (PeAF). We evaluated the relation between the LA wall composition by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) and the CFAE in patients with PeAF. Forty-three patients underwent LGE-CMR and CFAE mapping before catheter ablation for PeAF. The LA wall substrates were classified into three: the fibrotic, intermediate, and normal substrates by using two thresholds of 2 standard deviation (2-SD) and 6-SD above the mean signal from the normal myocardium. For each of 12 preselected LA wall regions, the composition ratios (CRs) of fibrotic, indeterminate, and normal substrates were calculated as a percentage to the volume of LA wall region, and compared depending on the CFAE, respectively. The CR of normal substrate was significantly greater at the LA wall region with CFAE (52 ± 38 % vs. 20 ± 28 %, P < 0.01) than without CFAE. In contrast, the LA wall region with CFAE showed significantly lower CRs of intermediate substrate (39 ± 34 % vs. 57 ± 31 %, P < 0.01) and fibrotic substrate (7 ± 17 % vs. 21 ± 24 %, P < 0.01) than did the LA wall region without CFAE, respectively. Thus, the high CR (>18 %) of normal substrate predicted the CFAE at the corresponding LA wall region with 71 % sensitivity and 62 % specificity. In conclusion, the evaluation of LA wall normal substrate by LGE-CMR might be useful to predict the CFAE occurrence before catheter ablation of PeAF.
KW - Atrial fibrillation
KW - Fibrosis
KW - Left atrium
KW - Magnetic resonance imaging
KW - Myocardium
UR - http://www.scopus.com/inward/record.url?scp=84933672239&partnerID=8YFLogxK
U2 - 10.1007/s10554-015-0675-1
DO - 10.1007/s10554-015-0675-1
M3 - Article
C2 - 25957631
AN - SCOPUS:84933672239
SN - 1569-5794
VL - 31
SP - 1191
EP - 1199
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 6
ER -