title: Lack of regional association between atrial late gadolinium enhancement on cardiac magnetic resonance and atrial fibrillation rotors.
abstract: BACKGROUND
  The extent of left atrial (LA) late gadolinium enhancement (LGE), as a surrogate for fibrosis, has been associated with atrial fibrillation (AF) recurrence after catheter ablation. Furthermore, there is ex vivo evidence that islands of fibrosis may anchor fibrillatory rotors.
  
  
  OBJECTIVE
  The purpose of this study was to examine the anatomical association of AF rotors with LA and right atrial (RA) LGE on cardiac magnetic resonance.
  
  
  METHODS
  The cohort included 9 patients with persistent AF (mean age 61.1 ± 9.7 years) who underwent LGE cardiac magnetic resonance before AF ablation using the focal impulse and rotor modulation system. The extent of LA and RA LGE was quantified globally and in each of the 7 sectors: LA posterior/inferior wall, anterior wall, roof, left and right pulmonary vein antra, and RA lateral and septal regions. The multivariable association of rotor incidence with global and per sector LGE extent was examined using multivariable Bernoulli logistic regression estimated by generalized estimating equations.
  
  
  RESULTS
  The mean RA and LA volumes were 113.2 ± 37.31 and 143.03 ± 58.25 mL, respectively. The mean RA and LA LGE burden was 17.2% ± 11.0% and 17.4% ± 14.4%, respectively. A total of 18 LA rotors and 9 RA rotors were identified in all patients. No univariable or multivariable association was observed between global or per sector LGE extent and focal impulse and rotor modulation rotor incidence.
  
  
  CONCLUSIONS
  In this cohort of patients, there was no association between AF rotor incidence and the global or regional extent of RA and LA LGE.
authors.affiliation: Department of Cardiology. Electronic address: chrispin@jhmi.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chrispin
authors.affiliation: Department of Cardiology.
authors.forename: Esra
authors.initials: E
authors.lastname: Gucuk Ipek
authors.affiliation: Department of Biomedical Engineering.
authors.forename: Sohail
authors.initials: S
authors.lastname: Zahid
authors.affiliation: Department of Biomedical Engineering.
authors.forename: Adityo
authors.initials: A
authors.lastname: Prakosa
authors.affiliation: Department of Cardiology.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Habibi
authors.affiliation: Department of Cardiology.
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.affiliation: Department of Cardiology.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Department of Cardiology.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ashikaga
authors.affiliation: Department of Cardiology.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Department of Biomedical Engineering.
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Trayanova
authors.affiliation: Department of Radiolog.
authors.forename: Stefan L
authors.initials: SL
authors.lastname: Zimmerman
authors.affiliation: Department of Biostatistics.
authors.forename: Vadim
authors.initials: V
authors.lastname: Zipunnikov
authors.affiliation: Department of Cardiology; Department of Biomedical Engineering.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.affiliation: Department of Cardiology.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Department of Cardiology; Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D016279:Atrial Function, Left / Q000502:physiology*; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium / Q000494:pharmacology*; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D005682:Gadolinium
keywords: Atrial fibrillation; Delayed enhancement magnetic resonance imaging; Fibrosis; Rotor