Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging
Year: 2024
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Atrial late gadolinium enhancement (Atrial-LGE) and electroanatomic voltage mapping (Atrial-EAVM) quantify the anatomical and functional extent of atrial cardiomyopathy. We aimed to explore the relationships between, and outcomes from, these modalities in patients with atrial fibrillation undergoing ablation. METHODS: Patients undergoing first-time ablation had disease severities quantified using both Atrial-LGE and Atrial-EAVM. Correlations between modalities and their relationships with clinical features and arrhythmia recurrence were assessed. RESULTS: In 123 atrial fibrillation patients (60 ± 10 years), Atrial-EAVM was moderately correlated with Atrial-LGE (r = .34, p < .001), with a mean fibrosis burden of 47.2% ± 14.91%. Agreement was strongest in the highest tertile of fibrosis burden (mean of differences 16.8% (95% CI = -24.4% to 57.9%, p = .433). Fibrosis burden was greater for Atrial-LGE than Atrial-EAVM (50.7% ± 10.7% vs. 13.7% ± 7.13%, p < .005) for patients in the lowest tertile who were younger, had smaller atria and a greater frequency of paroxysmal atrial fibrillation. Both Atrial EAVM and Atrial LGE were associated with recurrence of arrhythmia following ablation (Atrial-LGE HR = 1.02 (95% CI = 1.01-1.04), p = .047; Atrial-EAVM HR = 1.02 (95% CI = 1.005-1.03), p = .007). A low fibrosis burden (<15%) by Atrial-EAVM identified patients with very low arrhythmia recurrence. In contrast, a much higher fibrosis burden (>66%) by Atrial-LGE identified patients failing to respond to ablation. CONCLUSIONS: We demonstrate for the first time that the level of agreement between Atrial-EAVM and Atrial-LGE is dependent on the level of atrial cardiomyopathy disease severity. The functional consequences of atrial cardiomyopathy are most evident in patients with the highest anatomical extent of disease.
DOI: 10.1111/jce.16462
Authors: Iain Sim, Jose Alonso Solis Lemus, Christopher O'Shea, Orod Razeghi, John Whitaker, Rahul Mukherjee, Daniel O'Hare, Noel Fitzpatrick, James Harrison, Ali Gharaviri, Louisa O'Neill, Irum Kotadia, Caroline H. Roney, Neil Grubb, David E. Newby, Marc R. Dweck, Pier‐Giorgio Masci, Matthew Wright, Amedeo Chiribiri, Steven Niederer, Mark O'Neill, Steven E. Williams
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,290
Awards: G1403862681, Development of novel computational approaches for human cardiac mapping data - Improving understanding and treatment of atrial fibrillation, G1484820322, G1493233644, G192667549, G2001474594, G2465337746, G3700353482, G4058705228, Fibre orientation and pathological change in conduction anisotropy in the left atrium, G5131124023, Informing atrial fibrillation rhythm control strategies using electrophysiological testing, cardiac imaging and computational modelling, Development of novel computational approaches for human cardiac mapping data - Improving understanding and treatment of atrial fibrillation, Research Excellence (round 3)
OpenAlex ID: W4405914189