Progress in the application of cardiac magnetic resonance to predict recurrence of atrial fibrillation after catheter ablation: A systematic review and -analysis.

BACKGROUND

This systematic review and -analysis aimed to assess changes in left atrial structure and function at baseline and after catheter ablation and their association with atrial fibrillation recurrence using cardiac magnetic resonance imaging (MRI).

METHODS

As of June 2024, a total of 3086 articles have been obtained through searching PubMed, Embase, and Cochrane databases. Standard mean differences and 95% confidence intervals were used to examine structural and functional changes of left atrium after catheter ablation and their relationship with recurrence of atrial fibrillation.

RESULTS

A total of 13 prospective cohort studies were included in the analysis. Decreased left atrial emptying capacity is seen in the short term after catheter ablation, and structural changes in the left atrium are seen in the long term (EFActive: SMD, 1.23, 95 % CI, 1.10-2.36, p < 0.05; EFTotal: SMD, 0.83, 95 % CI, 0.02-1.64, p < 0.05; MinLAV: SMD, 0.30, 95 % CI, 0.01-0.59, p < 0.05). Decrease in left atrial volume after catheter ablationis positively associated with the risk of recurrence of atrial fibrillation. (MaxLAV: SMD, 1.27, 95 % CI, 0.05, 2.49, p < 0.05; MaxLAVi: SMD, 0.48, 95 % CI, 0.05,0.9, p < 0.05;MinLAVi: SMD, 0.78, 95 % CI, 0.39,1.16, p < 0.05). The larger the left atrial volume and the lower the emptying and strain function, the greater the likelihood of recurrence of atrial fibrillation following catheter ablation, (MaxLAV: SMD, 0.38, 95 % CI, 0.18,0.59, p < 0.05;MinLAV: SMD, 0.83,95 % CI, 0.41,1.24, p < 0.05; MaxLAVi: SMD, 0.35, 95 % CI, 0.21,0.50, p < 0.05;MinLAVi: SMD, 0.62, 95 % CI, 0.47,0.78, p < 0.05; EFPassive: SMD, -0.57, 95 % CI, -0.78, -0.37, p < 0.05; EFActive: SMD, -0.62, 95 % CI, -1.08, -0.15, P < 0.05; EFTotal: SMD, -0.70, 95 % CI, -0.97, -0.44, P < 0.05; ℇCT: SMD, -0.61, 95 % CI, -0.90, -0.32, p < 0.05; PLAS: SMD, -1.22, 95 % CI, -1.87, -0.57, p < 0.05; ℇR: SMD, -0.50, 95 % CI, -0.79, -0.21, p < 0.05; PLAS: SMD, -1.22, 95 % CI, -1.87, -0.57, p < 0.05).

CONCLUSION

Short-term left atrial functional impairment can be observed after catheter ablation, while long-term reduction in left atrial volume can be seen. Changes in left atrial volume are likely to lead to the recurrence of atrial fibrillation, while alterations in left atrial function help maintain sinus rhythm. Larger left atrial volume and lower emptying and strain function at baseline assessment by cardiac magnetic resonance are more likely to lead to recurrence of atrial fibrillation after catheter ablation, which may be useful to identify those for whom catheter ablation has reduced success or for whom more aggressive ablation or medications may be useful.