title: Incidental LV LGE on CMR Imaging in Atrial Fibrillation Predicts Recurrence After Ablation Therapy.
abstract: OBJECTIVE
  This study sought to evaluate the prognostic significance of left ventricular late gadolinium enhancement (LV-LGE) incidentally found in atrial fibrillation (AF) patients who undergo ablation therapy.
  
  
  BACKGROUND
  LV-LGE provides prognostic information in patients with ischemic and nonischemic cardiomyopathies. However, data on the clinical significance of incidental LV-LGE in the AF population are limited.
  
  
  METHODS
  A total of 778 patients who were referred for radiofrequency ablation of AF underwent cardiac magnetic resonance examinations between June 2006 and January 2013. Patients with a history of myocardial infarction or ablation therapy were excluded. The presence of LV-LGE was assessed by experienced imaging physicians. Patients were followed for arrhythmia recurrence after the radiofrequency ablation procedure.
  
  
  RESULTS
  Of 598 patients included in the study, 60% were men with a mean age of 64 years and a median AF duration of 25 months. LV-LGE was detected in 39 patients (6.5%). There were 240 arrhythmia recurrences observed involving 40% of patients over a median follow-up period of 52 months. On univariate analysis, age (hazard ratio [HR]: 1.02; 95% confidence interval [CI]: 1.00 to 1.03), male sex (HR: 0.63; 95% CI: 0.47 to 0.86), diabetes (HR: 1.53; 95% CI: 1.03 to 2.27), CHADS2 score (HR: 1.19; 95% CI: 1.04 to 1.36), CHA2DS2-VASc score (HR: 1.18; 95% CI: 1.08 to 1.30), left atrial (LA) fibrosis (HR: 1.66; 95% CI: 1.41 to 1.96), LV-LGE (HR: 1.83; 95% CI: 1.11 to 3.03), persistent AF (HR: 1.52; 95% CI: 1.11 to 2.09), and LA area (HR: 1.03; 95% CI: 1.01 to 1.05) were significantly associated with arrhythmia recurrence. The recurrence rate was 69% in patients with LV-LGE compared with 38% in patients without LV-LGE (p < 0.001). In a multivariate model, LA fibrosis and LV-LGE were independent predictors of arrhythmia recurrence.
  
  
  CONCLUSIONS
  In AF patients without history of myocardial infarction, LV-LGE is a significant independent predictor of arrhythmia recurrence after ablation therapy.
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Promporn
authors.initials: P
authors.lastname: Suksaranjit
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Nazem
authors.initials: N
authors.lastname: Akoum
authors.affiliation: Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah; Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah.
authors.forename: Eugene G
authors.initials: EG
authors.lastname: Kholmovski
authors.affiliation: Division of Epidemiology, University of Utah, Salt Lake City, Utah.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Lowell
authors.initials: L
authors.lastname: Chang
authors.affiliation: Division of Epidemiology, University of Utah, Salt Lake City, Utah.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Damal
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Krishna
authors.initials: K
authors.lastname: Velagapudi
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Allen
authors.initials: A
authors.lastname: Rassa
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Erik
authors.initials: E
authors.lastname: Bieging
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Shridhar
authors.initials: S
authors.lastname: Challa
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Imran
authors.initials: I
authors.lastname: Haider
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McGann
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah. Electronic address: brent.wilson@hsc.utah.edu.
authors.forename: Brent D
authors.initials: BD
authors.lastname: Wilson
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005544:Forecasting; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D016276:Ventricular Function / Q000502:physiology*
chemical_list: D005682:Gadolinium
keywords: ablation therapy; atrial fibrillation; cardiac magnetic resonance; late gadolinium enhancement