Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany.
Adas 3D Medical SL, 08036 Barcelona, Spain.
Europace. 2022 Jul 21;24(7):1102-1111. doi: 10.1093/europace/euac010.
Atrial cardiomyopathy (ACM) is associated with increased arrhythmia recurrence rates after pulmonary vein isolation (PVI). We compare the most common left atrial (LA) late gadolinium enhancement magnetic resonance imaging (LGE-MRI)-methods [Utah-method and image intensity ratio (IIR)-methods] and endocardial voltage mapping for ACM-detection and outcome prediction after PVI for atrial fibrillation (AF).
In this prospective observational study, 37 ablation-naive patients (66 ± 9 years, 84% male) with persistent AF underwent LA-LGE-MRI and high-definition voltage and activation mapping (2129 ± 484 sites) in sinus rhythm prior to PVI. The MRI-post-processing-analyses were performed by two independent expert laboratories. Arrhythmia recurrence was recorded within 12 months following PVI. The global ACM-extent was highly variable: median LA low-voltage substrate (LA-LVS) was 12.9% at <1.0 mV and 2.7% at <0.5 mV; median LA-LGE-extent using the Utah-method was 18.3% and 0.03-93.1% using the IIR-methods. The LA activation time was significantly correlated with LA-LVS (r = 0.76 at <0.5 mV and r = 0.82 at <1.0 mV, both P < 0.0001), but not with LA-LGE-extent. The highest regional matching between LA-LVS <0.5 mV and LA-LGE was found for the anterior wall in 57% of patients using the Utah-method and in 59% using IIR 1.20. The corresponding values for the posterior wall were 19% and 38%, respectively. Arrhythmia recurrence occurred in 15(41%) patients. Freedom from arrhythmia was significantly lower in those with LA-LVS ≥2 cm2 at 0.5 mV but not in those with LGE ≥20% (Utah-stages III and IV): 43% vs. 81%, P = 0.009 and 50% vs. 67%, P = 0.338, respectively.
Comparison of the most common LA-LGE-MRI methods and endocardial voltage mapping revealed large discrepancies in global and regional ACM-extent.
心房心肌病（ACM）与肺静脉隔离（PVI）后心律失常复发率增加有关。我们比较了最常见的左心房（LA）晚期钆增强磁共振成像（LGE-MRI）方法[犹他州方法和图像强度比（IIR）方法]和心内膜电压图，用于检测 ACM 并预测 PVI 治疗心房颤动（AF）后的结果。
在这项前瞻性观察研究中，37 名未经消融的患者（66±9 岁，84%为男性）在 PVI 前处于窦性心律，接受了 LA-LGE-MRI 和高清晰度电压和激活图（2129±484 个部位）。MRI 后处理分析由两个独立的专家实验室进行。在 PVI 后 12 个月内记录心律失常复发情况。整体 ACM 范围变化很大：LA 低电压基质（LA-LVS）中位数<1.0 mV 为 12.9%，<0.5 mV 为 2.7%；使用犹他州方法的 LA-LGE 范围中位数为 18.3%，使用 IIR 方法的中位数为 0.03-93.1%。LA 激活时间与 LA-LVS 显著相关（<0.5 mV 时 r = 0.76，<1.0 mV 时 r = 0.82，均 P<0.0001），但与 LA-LGE 范围无关。使用犹他州方法，57%的患者在前壁发现 LA-LVS<0.5 mV 和 LA-LGE 之间具有最高的区域匹配，而 IIR 1.20 为 59%。后壁的相应值分别为 19%和 38%。15 名（41%）患者出现心律失常复发。LA-LVS≥2 cm2 at 0.5 mV 的患者心律失常无复发率明显低于 LA-LGE≥20%（犹他州 III 和 IV 期）的患者：43%比 81%，P=0.009 和 50%比 67%，P=0.338。
比较最常见的 LA-LGE-MRI 方法和心内膜电压图发现，整体和局部 ACM 范围存在较大差异。
