MRI Assessment of Ablation‐Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study

Abstract

Catheter ablation of AF targeting PVs rarely achieves permanent encircling scar in the intended areas. Overall atrial fibrosis present at baseline and residual fibrosis uncovered by ablation scar are associated with recurrent arrhythmia.

Three‐dimensional Integrated Functional, Structural, and Computational Mapping to Define the Structural “Fingerprints” of Heart‐Specific Atrial Fibrillation Drivers in Human Heart Ex Vivo

“…Moreover, development and progression of atrial fibrosis is widely accepted as one of the most important substrates for AF perpetuation by inducing marked local conduction abnormalities 4, 5. Recent clinical studies in AF patients using in vivo late gadolinium–enhanced MRI suggest that the extent and distribution of atrial fibrosis is a reliable predicator of catheter ablation success 6, 9. Our recent studies of human RA ex vivo using high‐resolution CE‐MRI directly demonstrated that the combination of increased intramural fibrotic strands, greater endo‐epicardial myofiber misalignment, and atrial thickness variation may create microanatomic tracks for stable reentrant AF drivers 7, 8…”

First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation

“…The initial results of rotor-guided ablation approaches are heterogeneous, 30,31 and the idea to ablate electric rotors needs further validation. 32 In addition, Akoum et al 29,33 recently reported their interesting ablation approach to target preprocedural fibrosis in patients with PERS. However, currently, we have to conclude that fibrosis from CMR cannot predict the presence of electric rotors based on standard anatomic segmentation, and further data are necessary to determine whether a rotor-based ablation strategy alone or a combination with another ablation target may have the potential to improve the outcomes after ablation for PERS.…”

Voltage mapping as a method of left atrial fibrosis evaluation

“…3. Зависимость эффективности процедуры РЧА-антральной изоляции легочных вен и индекса фиброза ЛП По данным мультицентрового исследования DACAAF [2,14], проведенного в 15 центрах США, Ев-ропы и Австралии, существует четкая взаимосвязь меж-ду степенью фиброза ЛП и результатами катетерной аблации. В нашей работе не получено статистически достоверных различий в среднеотдаленном периоде после катетерной аблации (при наличии тенденции), что, вероятно, связано с небольшими количеством па-циентов и длительностью наблюдения.…”

“…Работа из университета Utah -N. Akoum с соавто-рами [14], посвященная оценке уже выполненных кате-терных процедур (c годовой эффективностью в 65%) у больных с ФП, показала, что только 7% оперированных пациентов имеют «полноценные» (по данным МРТ) за-мкнутые рубцы вокруг всех коллекторов легочных вен и зависимость степени фиброза и частоты рецидивов.…”