Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA; Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA.
Department of Orthopedic Surgery, University of New Mexico, Albuquerque, New Mexico, USA.
JACC Clin Electrophysiol. 2021 Jul;7(7):896-908. doi: 10.1016/j.jacep.2020.11.008. Epub 2021 Feb 24.
This study sought to evaluate atrial fibrillation (AF) ablation outcomes based on scar patterns and contiguous area available for AF wavefronts to propagate.
The relevance of ablation scar pattern acting as a barrier for electrical propagation in recurrence after catheter ablation for persistent AF is unknown.
Three-month post-ablation atrial cardiac magnetic resonance was used to determine post-ablation scar. The left atrium (LA) was divided into 5 areas based on anatomical landmarks and scar patterns. The length of gaps in scar on the area boundaries was used to calculate fibrillatory areas (FAs) by adding the weighted contribution of adjacent areas. Cylindrical as well as patient-specific computational models were used to further confirm findings.
A total of 75 patients that underwent an initial ablation for AF with 2 years of follow-up were included. The average maximum FA was 7,896 ± 1,988 mm in patients with recurrence (n = 40) and 6,559 ± 1,784 mm in patients without recurrence (n = 35) (p < 0.008). After redo ablation in 19 patients with recurrence, average maximum FA was 7,807 ± 1,392 mm in 9 patients with recurrence and 5,030 ± 1,765 mm in 10 without recurrence (p < 0.007). LA volume and total scar were not significant predictors of recurrence after the first ablation. In the cylindrical model, AF self-terminated after reducing the FAs. In the patient-specific models, simulation matched the clinical outcomes with larger FAs associated with post-ablation arrhythmia recurrences.
This data provides mechanistic insights into AF recurrence, suggesting that post-ablation scar pattern dividing the atria into smaller regions is an important and better predictor than LA volume and total scar, with improved long-term outcomes in persistent AF.
本研究旨在评估基于消融后瘢痕形态和可供房颤波阵面传播的连续区域，房颤（AF）消融的结果。
持续性房颤导管消融后复发时，消融后瘢痕作为电传播障碍的相关性尚不清楚。
使用 3 个月时的心脏磁共振评估消融后的瘢痕。根据解剖标志和瘢痕形态，将左心房（LA）分为 5 个区域。通过添加相邻区域的加权贡献，使用瘢痕区边界处的间隙长度来计算纤维颤动区（FA）。还使用了圆柱状和患者特异性计算模型来进一步确认发现。
共纳入 75 例因房颤行初次消融且有 2 年随访的患者。复发组（n=40）和未复发组（n=35）的平均最大 FA 分别为 7896±1988mm 和 6559±1784mm（p<0.008）。在 19 例复发患者中进行了再次消融后，9 例复发患者的平均最大 FA 为 7807±1392mm，10 例未复发患者为 5030±1765mm（p<0.007）。首次消融后，LA 容积和总瘢痕均不是复发的显著预测因素。在圆柱模型中，减少 FA 后房颤自行终止。在患者特异性模型中，模拟结果与临床结果相符，较大的 FA 与消融后心律失常复发相关。
这些数据为房颤复发提供了机制上的见解，表明消融后将心房分为较小区域的瘢痕形态是一个重要的、比 LA 容积和总瘢痕更好的预测因素，在持续性房颤中具有更好的长期预后。
