title: Relationship between left atrial tissue structural remodelling detected using late gadolinium enhancement MRI and left ventricular hypertrophy in patients with atrial fibrillation.
abstract: OBJECTIVE
  Therapeutic effectiveness of ablation of atrial fibrillation (AF) is related to cardiovascular comorbidities. We studied the relationship between left ventricular hypertrophy (LVH) and left atrial tissue structural remodelling (LA-SRM), in patients presenting for AF ablation.
  
  
  RESULTS
  We identified 404 AF patients who received a late gadolinium enhancement magnetic resonance imaging (LGE-MRI) prior to catheter ablation. Left ventricular hypertrophy was defined as LV mass index >116 g/m(2) in men and >104 g/m(2) in women. One hundred and twenty-two patients were classified as the LVH group and 282 as the non-LVH group. We stratified patients into four stages based on their degree of LA-SRM (minimal, <5% fibrosis; mild, >5-20%; moderate, >20-35%; and extensive, >35%). All patients underwent catheter ablation with pulmonary vein isolation and posterior wall and septal debulking. The procedural outcome was monitored over a 1-year follow-up period. The mean LA-SRM was significantly higher in patients with LVH (19.4 ± 13.2%) than in non-LVH patients (15.3 ± 9.8%; P< 0.01). Patients with LVH generally had extensive LA-SRM (moderate and extensive stages; 38.5% of LVH group) as compared with non-LVH patients (23.1% of non-LVH group; P < 0.01). A Cox regression analysis showed that patients with LVH also had significantly higher AF recurrence rates than non-LVH patients (43.2 vs. 28%; P = 0.008) during the 1-year follow-up period post-ablation.
  
  
  CONCLUSIONS
  Patients with LVH tend to have a significantly greater degree of LA-SRM, when compared with patients without LVH. Moreover, LA-SRM is a predictor for procedural success in patients undergoing AF ablation procedure.
authors.affiliation: Comprehensive Arrhythmia Research and Management (CARMA) Center, University of Utah, Salt Lake City, UT 84108, USA.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akkaya
authors.forename: Koji
authors.initials: K
authors.lastname: Higuchi
authors.forename: Matthias
authors.initials: M
authors.lastname: Koopmann
authors.forename: Nathan
authors.initials: N
authors.lastname: Burgon
authors.forename: Ercan
authors.initials: E
authors.lastname: Erdogan
authors.forename: Kavitha
authors.initials: K
authors.lastname: Damal
authors.forename: Eugene
authors.initials: E
authors.lastname: Kholmovski
authors.forename: Chris
authors.initials: C
authors.lastname: McGann
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D005355:Fibrosis; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D015999:Multivariate Analysis; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine
keywords: Atrial fibrillation; Catheter ablation; Left ventricular hypertrophy; MRI; Structural remodelling