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Active Atrial Function and Atrial Scar Burden After Multiple Catheter Ablations of Persistent Atrial Fibrillation
Author(s) -
NÜHRICH JANA M.,
GEISLER ANNE C.,
STEVEN DANIEL,
HOFFMANN BORIS A.,
SCHÄFFER BENJAMIN,
LUND GUNNAR,
STEHNING CHRISTIAN,
RADUNSKI ULF K.,
SULTAN ARIAN,
SCHWARZL MICHAEL,
ADAM GERHARD,
WILLEMS STEPHAN,
MUELLERLEILE KAI
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13004
Subject(s) - medicine , cardiology , atrial fibrillation , catheter ablation , sinus rhythm , ablation , cardioversion
Background Extensive and repeated substrate modification (SM) is frequently performed as an ablation strategy in persistent atrial fibrillation (persAF). The effect of these extended ablation strategies on atrial function has not been investigated sufficiently so far. The purpose was to assess atrial function by cardiac magnetic resonance (CMR) and its association with left atrial (LA) scar burden by electroanatomical voltage‐mapping after multiple persAF ablation procedures. Methods We included 16 persAF patients who had ≥2 SM procedures and a control group (CG) of 21 persAF patients without prior ablation. CMR was performed in sinus rhythm at least 4 weeks after the last cardioversion. Active left and right (RA) atrial emptying fractions (AEF) as well as peak active left atrial appendage (LAA) emptying velocities were obtained by CMR flow measurements. Furthermore, LA scar burden was quantified on electroanatomical voltage maps by the portion of points with local voltage amplitude <0.2 mV. Results We found median LA‐AEF to be lower (13 [9–22] vs 32 [26–36] %, P < 0.001) and median LA scar burden to be higher (40 [20–68] vs nine [3–18] %, P < 0.05) in the SM group compared with the CG. Furthermore, a significant correlation was found between mean LA voltage and LA‐AEF (r 2 = 0.62, P < 0.001). No significant differences were detected with respect to median RA‐AEF (41 [28–48] vs 47 [35–50] %, P = 0.43) and median peak LAA emptying velocities (30 [16–40] vs 17 [13–28] cm/s, P = 0.07). Conclusions Active LA function is preserved but significantly impaired and associated with ablation‐related LA scar burden after multiple extensive persAF ablations.