Abstract 12519: Degree of Left Atrial Structural Remodeling Predicts Outcome in Patients With Atrial Fibrillation using the Cryoballoon for Pulmonary Vein Isolation - Lessons learned From LGE-MRI
Background: Cryoballoon ablation is an alternative energy source for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF). Degree of structural remodeling of the left atrium (LA-SRM) detected using Late-Gadolinium Enhancement-MRI (LGE-MRI) is know as an independent predictor for success rate using radio-frequency (RF) energy for PVI in patients with PAF.
Methods and Result: Eighty-three patients with PAF (53 male, mean age 61.2±10.6 years old) were included into this study. All patients underwent LGE-MRI (MRI Verio 3T, Siemens, Erlangen, Germany) to quantify the degree of structural remodeling (SRM) of the LA. Based on the degree of SRM patients were stage into two groups: in patients with early stages of LA-SRM (e.g. ≤20% of the LA, Utah Stage 1 & 2, Group A) and in patients with progressed stages of LA-SRM (>20% of the LA, Utah 3&4, Group B). 52 (62.7%) patients were staged in Group A, while 31 patients (37.3%) were stage in Group B (Figure 1,blue columns). A total of 14 patients (16.87%) were found with recurrent AFIB 90 days after ablation. Success rate at 3 months after PVI was significant better in patients with early stages of structural remodeling of LA (90.38% vs 70.97%, p=0.022; Figure 1, red columns). Degree of LA-SRM detected using LGE-MRI was significant higher in patients with recurrence (21.97%±8.6% vs. 16.68%±7.42%; p=0.021, Figure 2).
Conclusion: From our preliminary results the degree of LA-SRM detected using LGE-MRI predicts success rates for Cryoballoon-Ablation in patients with paroxysmal atrial fibrillation. As patients with paroxysmal AF can show varying degrees of LA-SRM, LGE-MRI for assessment of the degree of LA-SRM might be able to support the choice of the adequate energy source for PVI in these patients.
- © 2013 by American Heart Association, Inc.