Identification of left atrial fibrosis with a late-enhancement MR sequence (LE-MR): preliminary results

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• 作者：Giulia Casagranda (1)
  Elena Costanza dal Piaz (2)
  Daniele Ravanelli (3)
  Maurizio Del Greco (2)
  Massimiliano Marini (2)
  Aldo Valentini (3)
  Maurizio Centonze (1)
  
• 关键词：Atrial fibrillation ; Atrial fibrosis ; Magnetic resonance ; Late enhancement
• 刊名：La radiologia medica
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：119
• 期：8
• 页码：595-600
• 全文大小：655 KB
• 参考文献：1. Kannel WB, Abbott RD, Savage DD et al (1982) Epidemiologic features of atrial fibrillation: the Framingham study. N Engl J Med 306:1018-022. doi:10.1056/NEJM198204293061703 CrossRef
  2. Raviele A, Disertori M, Alboni A (2011) Linee guida AIAC 2010 per la gestione e il trattamento della fibrillazione atriale. G Ital Cardiol 12(Suppl 1):1-2
  3. Gallagher MM, Camm J (1998) Classification of atrial fibrillation. Am J Cardiol 82(16):18N-8N CrossRef
  4. Haissaguerre M, Jais P, Shah D et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659-66. doi:10.1056/NEJM199809033391003 CrossRef
  5. Jais P, Cauchemez B, Macle L et al (2008) Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation 118:2498-505. doi:10.1161/CIRCULATIONAHA.108.772582 CrossRef
  6. Wilber DJ, Pappone C, Neuzil P et al (2010) Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA 303:333-40. doi:10.1001/jama.2009.2029 CrossRef
  7. Cappato R, Calkins H, Chen SA et al (2010) Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 3:32-8. doi:10.1161/CIRCEP.109.859116 CrossRef
  8. Calkins H, Kuck KH, Cappato R et al (2012) 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. A report of the Heart Rhythm Society (HRS) task force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 9(632):696. doi:10.1016/j.hrthm.2011.12.016
  9. Allessie M, Ausma J, Schotten U (2002) Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 54:230-46. doi:10.1016/S0008-6363(02)00258-4 CrossRef
  10. Wijffels MC, Kirchhof CJ, Dorland R et al (1995) Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 92:1954-968. doi:10.1161/01.CIR.92.7.1954 CrossRef
  11. Ausma J, Wijffels M, Thone F et al (1997) Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat. Circulation 96:3157-163. doi:10.1161/01.CIR.96.9.3157 CrossRef
  12. Burstein B, Nattel S (2008) Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol 51:802-09. doi:10.1016/j.jacc.2007.09.064 CrossRef
  13. Oakes RS, Badger TJ, Kholmovski EG et al (2009) Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation 119:1758-767. doi:10.1161/CIRCULATIONAHA.108.811877 CrossRef
  14. Akoum N, Daccarett M, McGann C et al (2011) Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach. J Cardiovasc Electrophysiol 22:16-2. doi:10.1111/j.1540-8167.2010.01876.x CrossRef
  15. Verma A, Wazni OM, Marrouche NF et al (2005) Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure. J Am Coll Cardiol 18:285-92. doi:10.1016/j.jacc.2004.10.035 CrossRef
  16. Altman DG (1991) Practical statistics for medical research. Chapman and Hall, London
  17. De Ponti R (2004) Sistemi di elettromappaggio non convenzionali. In: Delise P (ed) Le aritmie. Diagnosi prognosi e terapia. Casa Editrice Scientifica Internazionale Publ, Roma, pp 429-32
  18. Vergara GR, Marrouche NF (2011) Tailored management of atrial fibrillation using a LGE-MRI based model: from the clinic to the electrophysiology laboratory. J Cardiovasc Electrophysiol 22:481-87. doi:10.1111/j.1540-8167.2010.01941.x CrossRef
  19. Beinart R, Abbara S, Blum A et al (2011) Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation. J Cardiovasc Electrophysiol 22:1232-236. doi:10.1111/j.1540-8167.2011.02100.x CrossRef
  20. McGann CJ, Kholmovski EG, Oakes RS et al (2008) New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J Am Coll Cardiol 52:1263-271. doi:10.1016/j.jacc.2008.05.062 CrossRef
  21. Badger TJ, Daccarett M, Akoum NW et al (2010) Evaluation of left atrial lesions after initial and repeat atrial fibrillation ablation: lessons learned from delayed-enhancement MRI in repeat ablation procedures. Circ Arrhythm Electrophysiol 3:249-59. doi:10.1161/CIRCEP.109.868356 CrossRef
  22. Spragg DD, Khurram I, Zimmerman SL et al (2012) Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Heart Rhythm 9:2003-009. doi:10.1016/j.hrthm.2012.08.039 CrossRef
  23. Peters DC, Shaw JL, Knowles BR et al (2013) Respiratory bellows-gated late gadolinium enhancement of the left atrium. J Magn Reson Imaging 38:1210-214. doi:10.1002/jmri.23954
  24. Zhong H, Lacomis JM, Schwartzman D (2007) On the accuracy of CartoMerge for guiding posterior left atrial ablation in man. Heart Rhythm 4:595-02. doi:10.1016/j.hrthm.2007.01.033 CrossRef
  25. Malchano ZJ, Neuzil P, Cury RC et al (2006) Integration of cardiac CT/MR imaging with three-dimensional electroanatomical mapping to guide catheter manipulation in the left atrium: implications for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17:1221-229. doi:10.1111/j.1540-8167.2006.00616.x CrossRef
  26. Di Cesare E, Cademartiri F, Carbone I et al (2013) Indicazioni cliniche per l’utilizzo della cardio RM. A cura del Gruppo di lavoro della Sezione di Cardio-Radiologia della SIRM. Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging. Radiol Med 118:752-98. doi:10.1007/s11547-012-0899-2
  
• 作者单位：Giulia Casagranda (1)
  Elena Costanza dal Piaz (2)
  Daniele Ravanelli (3)
  Maurizio Del Greco (2)
  Massimiliano Marini (2)
  Aldo Valentini (3)
  Maurizio Centonze (1)
  
  1. Dipartimento di Diagnostica Per Immagini, APSS di Trento, L.go Medaglie d’Oro 10, 38100, Trento, Italy
  2. U.O. di Cardiologia, Ospedale S. Chiara APSS di Trento, Trento, Italy
  3. Servizio di Fisica Sanitaria, Ospedale S. Chiara APSS di Trento, Trento, Italy
  
• ISSN：1826-6983

文摘

Purpose This study was done to identify left atrial fibrosis in a group of consecutive patients with atrial fibrillation (AF) candidate for percutaneous radiofrequency catheter ablation (RFCA) by using a late-enhancement magnetic resonance (LE-MR) sequence, and to validate the technique by comparison with electroanatomical mapping (EAM). Materials and methods We enrolled 37 patients (29 males; mean age, 61?years) candidate for percutaneous RFCA of AF, who were studied with LE-MR and EAM. To identify left AF we used a three-dimensional LE sequence with cardiac gating and respiratory navigator. The EAM study involved the acquisition of 200 points in the left atrium (LA). The LA was divided into seven segments (pulmonary vein antra, floor, anterior wall, posterior wall-roof). Two blinded radiologists assessed the presence of fibrosis (area of hyperintense signal), reaching a consensus in discordant cases. Inter-observer variability was also evaluated to estimate the reproducibility of the method. We analysed the anatomical agreement between the results obtained with LE-MR imaging and EAM. Results Five patients were excluded because of to poor image quality. As for the other 32 patients, inter-observer agreement was good [Cohen’s kappa κ?=?0.72 with 95?% confidence interval (CI) of 0.55, 0.89]. In the classification of LA segments affected by fibrosis, LE-MR had a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 66?% (95?% CI 53.7?%, 77.2?%); 87?% (95?% CI 80.9?%, 91.9?%); 69?% (95?% CI 56.5?%, 80.1?%); 85.5?% (95?% CI 79.1?%, 90.6?%) and 81?% (95?% CU 75.1?%, 85.7?%). Conclusions Despite the small size of the sample studied, the LE-MR sequence proved more useful for excluding the presence of AF than for confirming its existence. Identification of AF prior to RFCA is paramount to select those patients who are truly amenable to the ablation procedure, which is expensive and not entirely free of risks.