Comprehensive Arrhythmia Research & Management (CARMA) Center, University of Utah, Salt Lake City, Utah.
Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
Pacing Clin Electrophysiol. 2020 Apr;43(4):402-411. doi: 10.1111/pace.13866.
Left atrial (LA) fibrosis is thought to be a substrate for atrial fibrillation (AF) and can be quantified by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). Fibrosis formation in LA is a dynamic process and may either progress or regress following AF ablation. We examined the impact of postablation progression in LA fibrosis on AF recurrence.
LA enhancement in LGE-MRI was quantified in 127 consecutive patients who underwent first time AF ablation. Serial LGE-MRIs were done prior to AF ablation, 3 months postablation and at least 12 months after second LGE-MRI. Transient postablation lesion (TL) was defined as atrial enhancement caused by ablation lesions that was detected on the first (3 month) but not on the second postablation LGE-MRI. New fibrosis (NF) was defined as atrial enhancement detected on the most recent LGE-MRI, at least 15 months after the ablation procedure. AF recurrence and its correlation with TL and NF was assessed in all patients during the follow-up period.
An increase of 1% NF increased the chance of postablation AF recurrence by 3% (hazard ratio [HR] 1.03, 95% CI 1-1.06, P = .05). TL had no significant impact on recurrence (P = .057). After adjusting for cardiovascular risk factors, HR increased as NF became greater. Greater volume of NF (≥21%) corresponded with lower arrhythmia-free survival (37% vs 62%, P = .01).
NF formation postablation of AF is a novel marker of long-term procedural outcome. Extensive NF is associated with significantly higher risk of atrial arrhythmia recurrence.
左心房（LA）纤维化被认为是心房颤动（AF）的基础，并可以通过晚期钆增强磁共振成像（LGE-MRI）进行量化。LA 中的纤维化形成是一个动态过程，在 AF 消融后可能会进展或消退。我们研究了 LA 纤维化消融后进展对 AF 复发的影响。
对 127 例首次接受 AF 消融的患者进行 LGE-MRI 检查，以量化 LA 增强。在 AF 消融前、消融后 3 个月和第二次 LGE-MRI 后至少 12 个月进行了连续的 LGE-MRI。短暂消融后病变（TL）定义为消融病变引起的心房增强，在第一次（3 个月）但不在第二次消融后 LGE-MRI 上检测到。新纤维化（NF）定义为在最近的 LGE-MRI 上检测到的心房增强，至少在消融后 15 个月。在随访期间，评估所有患者的 AF 复发及其与 TL 和 NF 的相关性。
NF 增加 1%，使消融后 AF 复发的几率增加 3%（危险比 [HR] 1.03，95%置信区间 1-1.06，P=0.05）。TL 对复发无显著影响（P=0.057）。调整心血管危险因素后，NF 越大，HR 越高。NF 体积越大（≥21%）与心律失常无复发率降低相关（37% vs 62%，P=0.01）。
AF 消融后 NF 的形成是长期手术结果的新标志物。广泛的 NF 与心房心律失常复发的风险显著增加相关。
