Keywords:
Computer Applications-Detection, diagnosis, Contrast agent-intravenous, Ablation procedures, MR, Cardiac, Outcomes, Connective tissue disorders
Authors:
H. Nivet, G. L. Chevreau, M. Salel, T. Ait Ali, O. Corneloup, V. Latrabe, M. Montaudon, F. Laurent, H. Cochet; Pessac/FR
Results
Baseline and follow-up characteristics
Baseline characteristics are shown in Table 1.
The number of procedures required to restore sinus rhythm without recurrence was 2.2±0.7.
The cumulative duration of RF delivery over the procedures was 126±37 min.
Mean follow-up since first procedure was 80±15 months.
Follow-up characteristics are shown in Table 2.
Scar extent was 29±6% in LA,
and 4.3±2.8% in RA.
LAEF,
LAAEF,
LAEI,
and trans-mitral A wave peak were found impaired whereas RA function was found preserved.
A wave was absent in 9/26 patients on trans-mitral flows,
and none of the patients on trans-tricuspid flows.
LAA was found mechanically isolated in 3 patients and severely delayed in 2 patients.
Figure 1 illustrates severe impairment of LA contractility and compliance on cine imaging.
Figure 2 illustrates the absence of A wave on trans-mitral flows in the same patient.
Figure 3 illustrates extensive scar burden in the LA wall in 6 patients with history of PsAF ablation.
Correlates of atrial scar
Correlates of atrial scar are shown in Table 3.
Among baseline characteristics,
LA scar extent at follow-up was fairly correlated with the number of procedures and total RF duration.
Among follow-up characteristics,
a good inverse correlation was found between LA scar extent and LAEF,
LAAEF,
LAEI and A wave peak velocity.
A fair positive correlation was also found between LA scar extent and inter-appendage delay.
In contrast,
RA scar extent was fairly correlated with the total number of procedures,
but no relationship was found with the RA parameters measured at follow-up.
Determinants of atrial contractile function
Correlates of atrial contractile function are shown in Table 4.
Among baseline characteristics,
LAAEF at follow-up was negatively related to the number of procedures and the total RF duration.
Among follow-up characteristics,
LAAEF was negatively related to LA scar extent.
At multivariable analysis LA scar extent was the only independent predictor of LAAEF impairment.
LA scar extent was higher in patients with mechanical delay or isolation of the LAA than in those without (35±3% vs 28±6%,
P=0.01).
It was also found higher when trans-mitral A wave was absent (34±3% vs 27±5%,
P=0.0007).