title: Diffuse ventricular fibrosis measured by T₁ mapping on cardiac MRI predicts success of catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  There is a complex interplay between the atria and ventricles in atrial fibrillation (AF). Cardiac magnetic resonance (CMR) imaging provides detailed tissue characterization, identifying focal ventricular fibrosis with late gadolinium enhancement (ventricular late gadolinium enhancement) and diffuse fibrosis with postcontrast-enhanced T1 mapping. The aim of the present study was to investigate the relationship between postcontrast ventricular T1 relaxation time on CMR and freedom from AF after pulmonary vein isolation.
  
  
  RESULTS
  One hundred three patients undergoing catheter ablation for symptomatic AF (66% paroxysmal AF; age, 58±10 years; left atrial area, 27±7 cm(2)) underwent preprocedure CMR to determine postcontrast ventricular T1 time. Follow-up included clinical review and 7-day Holter monitors at 6 monthly intervals. All patients underwent successful pulmonary vein isolation. At a mean follow-up of 15±7 months, the single procedure success was 74%. Postcontrast ventricular T1 time was significantly shorter in patients with recurrent AF (366±73 ms) versus patients without AF recurrence (428±90 ms; P=0.002). Univariate predictors of AF recurrence included postcontrast ventricular T1 time, AF type (paroxysmal versus persistent), AF duration, and body mass index. After multivariate analysis, ventricular T1 time (P=0.03) and AF duration (P=0.03) were the only independent predictors. Freedom from AF was present in 84% of patients with a postcontrast ventricular T1 time >380 ms versus 56% in patients with a postcontrast ventricular T1 time <380 ms (P=0.002).
  
  
  CONCLUSIONS
  A shorter postcontrast ventricular T1 relaxation time on CMR is associated with reduced freedom from AF after catheter ablation. Diffuse ventricular fibrosis as demonstrated by CMR may, in part, explain recurrent AF after AF ablation.
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Alex J A
authors.initials: AJ
authors.lastname: McLellan
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Liang-han
authors.initials: LH
authors.lastname: Ling
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Sonia
authors.initials: S
authors.lastname: Azzopardi
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Andris H
authors.initials: AH
authors.lastname: Ellims
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Leah M
authors.initials: LM
authors.lastname: Iles
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Michael A
authors.initials: MA
authors.lastname: Sellenger
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Morton
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.).
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.affiliation: From the Alfred Heart Centre, Alfred Hospital, Melbourne, Australia (A.J.A.M., L.-h.L., S.A., A.H.E., L.M.I., M.A.S., A.J.T., P.M.K.); Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia (A.J.A.M., L.-h.L., S.A, A.H.E, L.M.I., A.J.T., P.M.K.); Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.J.A.M., L.-h.L., J.B.M., J.M.K., P.M.K.). peter.kistler@bakeridi.edu.au.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D003287:Contrast Media; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: atrial fibrillation; fibrosis; magnetic resonance imaging