title: Left atrial passive emptying function determined by cardiac magnetic resonance predicts atrial fibrillation recurrence after pulmonary vein isolation.
abstract: BACKGROUND
  Although pulmonary vein isolation has become a mainstream therapy for selected patients with atrial fibrillation (AF), late recurrent AF is common and its risk factors remain poorly defined. The purpose of our study was to test the hypothesis that reduced left atrial passive emptying function (LAPEF) as determined by cardiac magnetic resonance has a strong association with late recurrent AF after pulmonary vein isolation.
  
  
  RESULTS
  Three hundred forty-six patients with AF referred for cardiac magnetic resonance pulmonary vein mapping before pulmonary vein isolation were included. Maximum LA volumes (VOLmax) and volumes before atrial contraction (VOLbac) were measured; LAPEF was calculated as (VOLmax-VOLbac)/VOLmax×100. Kaplan-Meier curves were constructed to determine late recurrent AF stratified by LAPEF quintile. Cox proportional hazards regression was used to adjust for known markers of recurrence. During a median follow-up of 27 months, 124 patients (35.8%) experienced late recurrent AF. Patients with recurrence were more likely to have nonparoxysmal AF (75.8% versus 51.4%; P<0.01), higher mean VOLmax (60.2 versus 52.8 mL/m(2); P<0.01), and lower mean LAPEF (19.1% versus 26.0%; P<0.01). Patients in the lowest LAPEF quintile were at highest risk of developing recurrent AF (2-year recurrence for lowest versus highest: 60.5% versus 17.3%; P<0.01). After adjusting for known predictors of recurrence, patients with low LAPEF remained significantly more likely to recur (hazard ratio for lowest versus highest quintile, 3.92; 95% confidence interval, 2.01-7.65).
  
  
  CONCLUSIONS
  We found a strong association between LAPEF and recurrent AF after pulmonary vein isolation that persisted after multivariable adjustment.
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Hoshang
authors.initials: H
authors.lastname: Farhad
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Steigner
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Roy
authors.initials: R
authors.lastname: John
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.affiliation: From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA. RYKwong@partners.org.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology*; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: atrial fibrillation; catheter ablation; magnetic resonance imaging