Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging

Iain Sim; Jose Alonso Solis Lemus; Christopher O'Shea; Orod Razeghi; John Whitaker; Rahul Mukherjee; Daniel O'Hare; Noel Fitzpatrick; James Harrison; Ali Gharaviri; Louisa O'Neill; Irum Kotadia; Caroline H. Roney; Neil Grubb; David E. Newby; Marc R. Dweck; Pier Giorgio Masci; Matthew Wright; Amedeo Chiribiri; Steven Niederer; Mark O'Neill; Steven E. Williams

doi:10.1111/jce.16462

Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging

Iain Sim^*, Jose Alonso Solis Lemus, Christopher O'Shea, Orod Razeghi, John Whitaker, Rahul Mukherjee, Daniel O'Hare, Noel Fitzpatrick, James Harrison, Ali Gharaviri, Louisa O'Neill, Irum Kotadia, Caroline H. Roney, Neil Grubb, David E. Newby, Marc R. Dweck, Pier Giorgio Masci, Matthew Wright, Amedeo Chiribiri, Steven NiedererMark O'Neill, Steven E. Williams

^*Corresponding author for this work

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

Abstract

Introduction: Atrial late gadolinium enhancement (Atrial-LGE) and electroanatomic voltage mapping (Atrial-EAVM) quantify the anatomical and functional extent of atrial cardiomyopathy. We aimed to explore the relationships between, and outcomes from, these modalities in patients with atrial fibrillation undergoing ablation. Methods: Patients undergoing first-time ablation had disease severities quantified using both Atrial-LGE and Atrial-EAVM. Correlations between modalities and their relationships with clinical features and arrhythmia recurrence were assessed. Results: In 123 atrial fibrillation patients (60 ± 10 years), Atrial-EAVM was moderately correlated with Atrial-LGE (r =.34, p <.001), with a mean fibrosis burden of 47.2% ± 14.91%. Agreement was strongest in the highest tertile of fibrosis burden (mean of differences 16.8% (95% CI = −24.4% to 57.9%, p =.433). Fibrosis burden was greater for Atrial-LGE than Atrial-EAVM (50.7% ± 10.7% vs. 13.7% ± 7.13%, p <.005) for patients in the lowest tertile who were younger, had smaller atria and a greater frequency of paroxysmal atrial fibrillation. Both Atrial EAVM and Atrial LGE were associated with recurrence of arrhythmia following ablation (Atrial-LGE HR = 1.02 (95% CI = 1.01–1.04), p =.047; Atrial-EAVM HR = 1.02 (95% CI = 1.005–1.03), p =.007). A low fibrosis burden (<15%) by Atrial-EAVM identified patients with very low arrhythmia recurrence. In contrast, a much higher fibrosis burden (>66%) by Atrial-LGE identified patients failing to respond to ablation. Conclusions: We demonstrate for the first time that the level of agreement between Atrial-EAVM and Atrial-LGE is dependent on the level of atrial cardiomyopathy disease severity. The functional consequences of atrial cardiomyopathy are most evident in patients with the highest anatomical extent of disease.

Original language	English
Journal	Journal of Cardiovascular Electrophysiology
DOIs	https://doi.org/10.1111/jce.16462
Publication status	Accepted/In press - 2024

Keywords

atrial fibrillation
bipolar voltage
fibrosis
late gadolinium enhancement

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10.1111/jce.16462

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Sim, I., Lemus, J. A. S., O'Shea, C., Razeghi, O., Whitaker, J., Mukherjee, R., O'Hare, D., Fitzpatrick, N., Harrison, J., Gharaviri, A., O'Neill, L., Kotadia, I., Roney, C. H., Grubb, N., Newby, D. E., Dweck, M. R., Masci, P. G., Wright, M., Chiribiri, A., ... Williams, S. E. (Accepted/In press). Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging. Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.16462

@article{7b79712847ee4bc3977a5e289b109d07,

title = "Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging",

abstract = "Introduction: Atrial late gadolinium enhancement (Atrial-LGE) and electroanatomic voltage mapping (Atrial-EAVM) quantify the anatomical and functional extent of atrial cardiomyopathy. We aimed to explore the relationships between, and outcomes from, these modalities in patients with atrial fibrillation undergoing ablation. Methods: Patients undergoing first-time ablation had disease severities quantified using both Atrial-LGE and Atrial-EAVM. Correlations between modalities and their relationships with clinical features and arrhythmia recurrence were assessed. Results: In 123 atrial fibrillation patients (60 ± 10 years), Atrial-EAVM was moderately correlated with Atrial-LGE (r =.34, p <.001), with a mean fibrosis burden of 47.2% ± 14.91%. Agreement was strongest in the highest tertile of fibrosis burden (mean of differences 16.8% (95% CI = −24.4% to 57.9%, p =.433). Fibrosis burden was greater for Atrial-LGE than Atrial-EAVM (50.7% ± 10.7% vs. 13.7% ± 7.13%, p <.005) for patients in the lowest tertile who were younger, had smaller atria and a greater frequency of paroxysmal atrial fibrillation. Both Atrial EAVM and Atrial LGE were associated with recurrence of arrhythmia following ablation (Atrial-LGE HR = 1.02 (95% CI = 1.01–1.04), p =.047; Atrial-EAVM HR = 1.02 (95% CI = 1.005–1.03), p =.007). A low fibrosis burden (<15%) by Atrial-EAVM identified patients with very low arrhythmia recurrence. In contrast, a much higher fibrosis burden (>66%) by Atrial-LGE identified patients failing to respond to ablation. Conclusions: We demonstrate for the first time that the level of agreement between Atrial-EAVM and Atrial-LGE is dependent on the level of atrial cardiomyopathy disease severity. The functional consequences of atrial cardiomyopathy are most evident in patients with the highest anatomical extent of disease.",

keywords = "atrial fibrillation, bipolar voltage, fibrosis, late gadolinium enhancement",

author = "Iain Sim and Lemus, {Jose Alonso Solis} and Christopher O'Shea and Orod Razeghi and John Whitaker and Rahul Mukherjee and Daniel O'Hare and Noel Fitzpatrick and James Harrison and Ali Gharaviri and Louisa O'Neill and Irum Kotadia and Roney, {Caroline H.} and Neil Grubb and Newby, {David E.} and Dweck, {Marc R.} and Masci, {Pier Giorgio} and Matthew Wright and Amedeo Chiribiri and Steven Niederer and Mark O'Neill and Williams, {Steven E.}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.",

year = "2024",

doi = "10.1111/jce.16462",

language = "English",

journal = "Journal of Cardiovascular Electrophysiology",

issn = "1045-3873",

publisher = "Wiley-Blackwell",

}

Sim, I , Lemus, JAS, O'Shea, C, Razeghi, O , Whitaker, J , Mukherjee, R , O'Hare, D, Fitzpatrick, N, Harrison, J, Gharaviri, A, O'Neill, L , Kotadia, I , Roney, CH, Grubb, N, Newby, DE, Dweck, MR, Masci, PG , Wright, M , Chiribiri, A , Niederer, S , O'Neill, M & Williams, SE 2024, 'Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.16462

TY - JOUR

T1 - Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging

AU - Sim, Iain

AU - Lemus, Jose Alonso Solis

AU - O'Shea, Christopher

AU - Razeghi, Orod

AU - Whitaker, John

AU - Mukherjee, Rahul

AU - O'Hare, Daniel

AU - Fitzpatrick, Noel

AU - Harrison, James

AU - Gharaviri, Ali

AU - O'Neill, Louisa

AU - Kotadia, Irum

AU - Roney, Caroline H.

AU - Grubb, Neil

AU - Newby, David E.

AU - Dweck, Marc R.

AU - Masci, Pier Giorgio

AU - Wright, Matthew

AU - Chiribiri, Amedeo

AU - Niederer, Steven

AU - O'Neill, Mark

AU - Williams, Steven E.

PY - 2024

Y1 - 2024

N2 - Introduction: Atrial late gadolinium enhancement (Atrial-LGE) and electroanatomic voltage mapping (Atrial-EAVM) quantify the anatomical and functional extent of atrial cardiomyopathy. We aimed to explore the relationships between, and outcomes from, these modalities in patients with atrial fibrillation undergoing ablation. Methods: Patients undergoing first-time ablation had disease severities quantified using both Atrial-LGE and Atrial-EAVM. Correlations between modalities and their relationships with clinical features and arrhythmia recurrence were assessed. Results: In 123 atrial fibrillation patients (60 ± 10 years), Atrial-EAVM was moderately correlated with Atrial-LGE (r =.34, p <.001), with a mean fibrosis burden of 47.2% ± 14.91%. Agreement was strongest in the highest tertile of fibrosis burden (mean of differences 16.8% (95% CI = −24.4% to 57.9%, p =.433). Fibrosis burden was greater for Atrial-LGE than Atrial-EAVM (50.7% ± 10.7% vs. 13.7% ± 7.13%, p <.005) for patients in the lowest tertile who were younger, had smaller atria and a greater frequency of paroxysmal atrial fibrillation. Both Atrial EAVM and Atrial LGE were associated with recurrence of arrhythmia following ablation (Atrial-LGE HR = 1.02 (95% CI = 1.01–1.04), p =.047; Atrial-EAVM HR = 1.02 (95% CI = 1.005–1.03), p =.007). A low fibrosis burden (<15%) by Atrial-EAVM identified patients with very low arrhythmia recurrence. In contrast, a much higher fibrosis burden (>66%) by Atrial-LGE identified patients failing to respond to ablation. Conclusions: We demonstrate for the first time that the level of agreement between Atrial-EAVM and Atrial-LGE is dependent on the level of atrial cardiomyopathy disease severity. The functional consequences of atrial cardiomyopathy are most evident in patients with the highest anatomical extent of disease.

AB - Introduction: Atrial late gadolinium enhancement (Atrial-LGE) and electroanatomic voltage mapping (Atrial-EAVM) quantify the anatomical and functional extent of atrial cardiomyopathy. We aimed to explore the relationships between, and outcomes from, these modalities in patients with atrial fibrillation undergoing ablation. Methods: Patients undergoing first-time ablation had disease severities quantified using both Atrial-LGE and Atrial-EAVM. Correlations between modalities and their relationships with clinical features and arrhythmia recurrence were assessed. Results: In 123 atrial fibrillation patients (60 ± 10 years), Atrial-EAVM was moderately correlated with Atrial-LGE (r =.34, p <.001), with a mean fibrosis burden of 47.2% ± 14.91%. Agreement was strongest in the highest tertile of fibrosis burden (mean of differences 16.8% (95% CI = −24.4% to 57.9%, p =.433). Fibrosis burden was greater for Atrial-LGE than Atrial-EAVM (50.7% ± 10.7% vs. 13.7% ± 7.13%, p <.005) for patients in the lowest tertile who were younger, had smaller atria and a greater frequency of paroxysmal atrial fibrillation. Both Atrial EAVM and Atrial LGE were associated with recurrence of arrhythmia following ablation (Atrial-LGE HR = 1.02 (95% CI = 1.01–1.04), p =.047; Atrial-EAVM HR = 1.02 (95% CI = 1.005–1.03), p =.007). A low fibrosis burden (<15%) by Atrial-EAVM identified patients with very low arrhythmia recurrence. In contrast, a much higher fibrosis burden (>66%) by Atrial-LGE identified patients failing to respond to ablation. Conclusions: We demonstrate for the first time that the level of agreement between Atrial-EAVM and Atrial-LGE is dependent on the level of atrial cardiomyopathy disease severity. The functional consequences of atrial cardiomyopathy are most evident in patients with the highest anatomical extent of disease.

KW - atrial fibrillation

KW - bipolar voltage

KW - fibrosis

KW - late gadolinium enhancement

UR - http://www.scopus.com/inward/record.url?scp=85213809192&partnerID=8YFLogxK

U2 - 10.1111/jce.16462

DO - 10.1111/jce.16462

M3 - Article

AN - SCOPUS:85213809192

SN - 1045-3873

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

ER -

Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging

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