Abstract 17160: Atrial Fibrosis as a Predictor for Atrial Fibrillation Ablation Success: 5 Years Follow up Study
Background: Left atrial (LA) fibrosis assessed by delayed enhancement (DE)-MRI has been shown in multiple studies to be strongly associated with AF and AF treatment outcome. In this study we assess the value of atrial fibrosis in predicting treatment success at 5 years follow up.
Methods: 208 consecutive patients (Mean age 63.0 ±12.2 years, 54% had paroxysmal AF and mean LA fibrosis score was 16.3 ±11.2%) undergoing PVI between 2006 and 2009 with a DE-MRI of sufficient quality for LA fibrosis assessment were retrospectively analyzed. LA fibrosis was classified into 4 UTAH stages as recently described (I: 0-10%; II: 10-20%; III: 20-30%; IV: >40%). Log-rank, Kruskal-Wallis and cox proportional hazard analyses were performed.
Results: After a median follow-up of 4.8 years (q1-q3: 0.9-6.1), overall AF free survival was 63% after a mean of 1.4 PVI attempts. Figure 1 depicts the significant difference in arrhythmia recurrences among UTAH stages (I: 28% II: 37%: III: 58% IV: 91%, P<0.001), as displayed in the figure. LA fibrosis was a significant predictor of long-term AF free survival (c-statistic: 0.669, P<0.001). The mean number of PVI attempts was significantly different among UTAH stages (I: 1.29, II: 1.32, III: 1.47, IV: 1.8, P=0.003). In multivariate analysis, CHA2DS2VASc score (OR: 1.302, P=0.014), LA volume (OR: 1.008, P=0.013) and LA fibrosis (OR: 1.037, P<0.001) were independently associated with AF free survival.
Conclusion: LA fibrosis assessed by DE-MRI is an independent predictor of 5-year AF free survival. Moreover, patients with advanced degree of atrial fibrosis seems to require higher number of repeat ablation procedures to maintain sinus rhythm.
Author Disclosures: P. Gal: None. G. Kaur: None. K.A. Johnson: None. P. Suksaranjit: None. A. Elvan: None. C.F. Pacchia: None. N.F. marrouche: Other; Significant; MARREK inc.
- © 2015 by American Heart Association, Inc.