A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation: prediction of long-term outcomes

Henry Chubb; Rashed Karim; Rahul Mukherjee; Steven E Williams; John Whitaker; James Harrison; Steven E Niederer; Wieland Staab; Jaspal Gill; Tobias Schaeffter; Matthew Wright; Mark O'Neill; Reza Razavi

doi:10.1111/jce.14111

A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation: prediction of long-term outcomes

Henry Chubb, Rashed Karim, Rahul Mukherjee, Steven E Williams, John Whitaker, James Harrison, Steven E Niederer, Wieland Staab, Jaspal Gill, Tobias Schaeffter, Matthew Wright, Mark O'Neill, Reza Razavi

Centre for the Developing Brain and Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners; St Thomas' Hospital; London UK
Department of Cardiology, Guy's and St. Thomas' Hospital, London SE1 7EH, London, UK.

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Abstract

INTRODUCTION: Multiple CMR-derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long-term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), LVEF, LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long-term single-center study.

METHODS AND RESULTS: 89 patients (53% PAF, 73% male) underwent comprehensive CMR study prior to first-time AF ablation (median follow-up 726days (IQR 418-1010days)). 3D LGE acquisition (1.5T, 1.3x1.3x2mm) was quantified for fibrosis, LA volume and sphericity assessed on manual segmentation at atrial diastole, LA and LV ejection fraction (EF) quantified on multi-slice cine imaging. AF recurred in 43 patients (48%) overall (31 at one year). In the recurrence group, LA fibrosis was higher (42% vs 29%, HR 1.032, p=0.002), LAEF lower (25% vs 34%, HR 0.063, p=0.016) and LVEF lower (57% vs 63%, HR 0.011, p=0.008). LA volume (63 vs 61 ml/m2) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (model 1), additionally AF type (model 2) and combined (model 3). In models 1 and 2, LA fibrosis, LAEF and LVEF were independently associated with outcome, but only LA fibrosis was independent in model 3 (HR 1.021, p=0.022).

CONCLUSIONS: LAEF, LVEF and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome. This article is protected by copyright. All rights reserved.

Original language	English
Pages (from-to)	1894-1903
Number of pages	10
Journal	Journal of Cardiovascular Electrophysiology
Volume	30
Issue number	10
Early online date	9 Aug 2019
DOIs	https://doi.org/10.1111/jce.14111
Publication status	Published - 1 Oct 2019

Keywords

atrial fibrillation
atrial fibrosis
cardiac magnetic resonance imaging
catheter ablation
structural remodeling

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A comprehensive multi‐index_CHUBB_Firstonline9Aug2019_GREEN AAMAccepted author manuscript, 1.09 MB

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Chubb, H., Karim, R., Mukherjee, R., Williams, S. E., Whitaker, J., Harrison, J., Niederer, S. E., Staab, W., Gill, J., Schaeffter, T., Wright, M., O'Neill, M., & Razavi, R. (2019). A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation: prediction of long-term outcomes. Journal of Cardiovascular Electrophysiology, 30(10), 1894-1903. https://doi.org/10.1111/jce.14111

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abstract = "INTRODUCTION: Multiple CMR-derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long-term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), LVEF, LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long-term single-center study.METHODS AND RESULTS: 89 patients (53% PAF, 73% male) underwent comprehensive CMR study prior to first-time AF ablation (median follow-up 726days (IQR 418-1010days)). 3D LGE acquisition (1.5T, 1.3x1.3x2mm) was quantified for fibrosis, LA volume and sphericity assessed on manual segmentation at atrial diastole, LA and LV ejection fraction (EF) quantified on multi-slice cine imaging. AF recurred in 43 patients (48%) overall (31 at one year). In the recurrence group, LA fibrosis was higher (42% vs 29%, HR 1.032, p=0.002), LAEF lower (25% vs 34%, HR 0.063, p=0.016) and LVEF lower (57% vs 63%, HR 0.011, p=0.008). LA volume (63 vs 61 ml/m2) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (model 1), additionally AF type (model 2) and combined (model 3). In models 1 and 2, LA fibrosis, LAEF and LVEF were independently associated with outcome, but only LA fibrosis was independent in model 3 (HR 1.021, p=0.022).CONCLUSIONS: LAEF, LVEF and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome. This article is protected by copyright. All rights reserved.",

keywords = "atrial fibrillation, atrial fibrosis, cardiac magnetic resonance imaging, catheter ablation, structural remodeling",

author = "Henry Chubb and Rashed Karim and Rahul Mukherjee and Williams, {Steven E} and John Whitaker and James Harrison and Niederer, {Steven E} and Wieland Staab and Jaspal Gill and Tobias Schaeffter and Matthew Wright and Mark O'Neill and Reza Razavi",

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doi = "10.1111/jce.14111",

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Chubb, H , Karim, R , Mukherjee, R , Williams, SE , Whitaker, J , Harrison, J , Niederer, SE, Staab, W, Gill, J, Schaeffter, T , Wright, M , O'Neill, M & Razavi, R 2019, 'A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation: prediction of long-term outcomes', Journal of Cardiovascular Electrophysiology, vol. 30, no. 10, pp. 1894-1903. https://doi.org/10.1111/jce.14111

A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation: prediction of long-term outcomes. / Chubb, Henry ; Karim, Rashed ; Mukherjee, Rahul et al.
In: Journal of Cardiovascular Electrophysiology, Vol. 30, No. 10, 01.10.2019, p. 1894-1903.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation

T2 - prediction of long-term outcomes

AU - Chubb, Henry

AU - Karim, Rashed

AU - Mukherjee, Rahul

AU - Williams, Steven E

AU - Whitaker, John

AU - Harrison, James

AU - Niederer, Steven E

AU - Staab, Wieland

AU - Gill, Jaspal

AU - Schaeffter, Tobias

AU - Wright, Matthew

AU - O'Neill, Mark

AU - Razavi, Reza

PY - 2019/10/1

Y1 - 2019/10/1

N2 - INTRODUCTION: Multiple CMR-derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long-term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), LVEF, LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long-term single-center study.METHODS AND RESULTS: 89 patients (53% PAF, 73% male) underwent comprehensive CMR study prior to first-time AF ablation (median follow-up 726days (IQR 418-1010days)). 3D LGE acquisition (1.5T, 1.3x1.3x2mm) was quantified for fibrosis, LA volume and sphericity assessed on manual segmentation at atrial diastole, LA and LV ejection fraction (EF) quantified on multi-slice cine imaging. AF recurred in 43 patients (48%) overall (31 at one year). In the recurrence group, LA fibrosis was higher (42% vs 29%, HR 1.032, p=0.002), LAEF lower (25% vs 34%, HR 0.063, p=0.016) and LVEF lower (57% vs 63%, HR 0.011, p=0.008). LA volume (63 vs 61 ml/m2) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (model 1), additionally AF type (model 2) and combined (model 3). In models 1 and 2, LA fibrosis, LAEF and LVEF were independently associated with outcome, but only LA fibrosis was independent in model 3 (HR 1.021, p=0.022).CONCLUSIONS: LAEF, LVEF and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome. This article is protected by copyright. All rights reserved.

AB - INTRODUCTION: Multiple CMR-derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long-term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), LVEF, LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long-term single-center study.METHODS AND RESULTS: 89 patients (53% PAF, 73% male) underwent comprehensive CMR study prior to first-time AF ablation (median follow-up 726days (IQR 418-1010days)). 3D LGE acquisition (1.5T, 1.3x1.3x2mm) was quantified for fibrosis, LA volume and sphericity assessed on manual segmentation at atrial diastole, LA and LV ejection fraction (EF) quantified on multi-slice cine imaging. AF recurred in 43 patients (48%) overall (31 at one year). In the recurrence group, LA fibrosis was higher (42% vs 29%, HR 1.032, p=0.002), LAEF lower (25% vs 34%, HR 0.063, p=0.016) and LVEF lower (57% vs 63%, HR 0.011, p=0.008). LA volume (63 vs 61 ml/m2) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (model 1), additionally AF type (model 2) and combined (model 3). In models 1 and 2, LA fibrosis, LAEF and LVEF were independently associated with outcome, but only LA fibrosis was independent in model 3 (HR 1.021, p=0.022).CONCLUSIONS: LAEF, LVEF and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome. This article is protected by copyright. All rights reserved.

KW - atrial fibrillation

KW - atrial fibrosis

KW - cardiac magnetic resonance imaging

KW - catheter ablation

KW - structural remodeling

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U2 - 10.1111/jce.14111

DO - 10.1111/jce.14111

M3 - Article

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SN - 1045-3873

VL - 30

SP - 1894

EP - 1903

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

IS - 10

ER -

A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation: prediction of long-term outcomes

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