title: Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF.
abstract: OBJECTIVE
  The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence.
  
  
  BACKGROUND
  Recurrent AF after catheter ablation has been reported to associate with the baseline extent of left atrial LGE on cardiac magnetic resonance. Traditional methods for measurement of intensity lack an objective threshold for quantification and interpatient comparisons of LGE.
  
  
  METHODS
  The cohort included 165 participants (mean age 60.0 ± 10.2 years, 77% men, 57% with persistent AF) who underwent initial AF ablation. The association of baseline LGE extent with AF recurrence was examined using multivariable Cox proportional hazards models. Multiplicative and additive interactions between AF type and LGE extent were examined.
  
  
  RESULTS
  During 10.2 ± 5.7 months of follow-up, 63 patients (38.2%) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10% increased LGE; p < 0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction.
  
  
  CONCLUSIONS
  Regardless of AF persistence at baseline, participants with LGE ≤35% have favorable outcomes, whereas those with LGE >35% have a higher rate of AF recurrence in the first year after ablation. These findings suggest a role for: 1) patient selection for AF ablation using LGE extent; and 2) substrate modification in addition to pulmonary vein isolation in patients with LGE extent exceeding 35% of left atrial myocardium.
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Irfan M
authors.initials: IM
authors.lastname: Khurram
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Habibi
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Esra
authors.initials: E
authors.lastname: Gucuk Ipek
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chrispin
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Eunice
authors.initials: E
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Fukumoto
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jane
authors.initials: J
authors.lastname: Dewire
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David D
authors.initials: DD
authors.lastname: Spragg
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ashikaga
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jack
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Vadim
authors.initials: V
authors.lastname: Zipunnikov
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Stefan L
authors.initials: SL
authors.lastname: Zimmerman
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: snazarian@jhmi.edu.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
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; D005260:Female; D019786:Gadolinium DTPA; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: atrial fibrillation; catheter ablation; late gadolinium enhancement; magnetic resonance imaging