title: Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach.
abstract: MRI for AF Patient Selection and Ablation Approach.
  
  
  BACKGROUND
  Left atrial (LA) fibrosis and ablation related scarring are major predictors of success in rhythm control of atrial fibrillation (AF). We used delayed enhancement MRI (DE-MRI) to stratify AF patients based on pre-ablation fibrosis and also to evaluate ablation-induced scarring in order to identify predictors of a successful ablation.
  
  
  RESULTS
  One hundred and forty-four patients were staged by percent of fibrosis quantified with DE-MRI, relative to the LA wall volume: minimal or Utah stage 1; <5%, mild or Utah stage 2; 5-20%, moderate or Utah stage 3; 20-35%, and extensive or Utah stage 4; >35%. All patients underwent pulmonary vein (PV) isolation and posterior wall and septal debulking. Overall, LA scarring was quantified and PV antra were evaluated for circumferential scarring 3 months post ablation. LA scarring post ablation was comparable across the 4 stages. Most patients had either no (36.8%) or 1 PV (32.6%) antrum circumferentially scarred. Forty-two patients (29%) had recurrent AF over 283 ± 167 days. No recurrences were noted in Utah stage 1. Recurrence was 28% in Utah stage 2, 35% in Utah stage 3, and 56% in Utah stage 4. Recurrence was predicted by circumferential PV scarring in Utah stage 2 and by overall LA wall scarring in Utah stage 3. No recurrence predictors were identified in Utah stage 4.
  
  
  CONCLUSIONS
  Circumferential PV antral scarring predicts ablation success in mild LA fibrosis, while posterior wall and septal scarring is needed for moderate fibrosis. This may help select the proper candidate and strategy in catheter ablation of AF.
authors.affiliation: Comprehensive Arrhythmia Research and Management (CARMA) Center, University of Utah, Salt Lake City, UT 84132, USA. nazem.akoum@hsc.utah.edu
authors.forename: Nazem
authors.initials: N
authors.lastname: Akoum
authors.forename: Marcos
authors.initials: M
authors.lastname: Daccarett
authors.forename: Chris
authors.initials: C
authors.lastname: McGann
authors.forename: Nathan
authors.initials: N
authors.lastname: Segerson
authors.forename: Gaston
authors.initials: G
authors.lastname: Vergara
authors.forename: Suman
authors.initials: S
authors.lastname: Kuppahally
authors.forename: Troy
authors.initials: T
authors.lastname: Badger
authors.forename: Nathan
authors.initials: N
authors.lastname: Burgon
authors.forename: Thomas
authors.initials: T
authors.lastname: Haslam
authors.forename: Eugene
authors.initials: E
authors.lastname: Kholmovski
authors.forename: Rob
authors.initials: R
authors.lastname: Macleod
authors.forename: Nassir
authors.initials: N
authors.lastname: Marrouche
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D014589:Utah / Q000453:epidemiology
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