Document Detail


Magnetic resonance imaging-confirmed ablative debulking of the left atrial posterior wall and septum for treatment of persistent atrial fibrillation: rationale and initial experience.
MedLine Citation:
PMID:  19804549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Though pulmonary vein (PV) isolation has been widely adopted for treatment of atrial fibrillation (AF), recurrence rates remain unacceptably high with persistent and longstanding AF. As evidence emerges for non-PV substrate changes in the pathogenesis of AF, more extensive ablation strategies need further study. METHODS: We modified our PV antrum isolation procedure to include abatement of posterior and septal wall potentials. We also employed recently described image-processing techniques using delayed-enhancement (DE) MRI to characterize tissue injury patterns 3 months after ablation, to assess whether each PV was encircled with scar, and to assess the impact of these parameters on procedural success. RESULTS: 118 consecutive patients underwent debulking procedure and completed follow-up, of which 86 underwent DE-MRI. The total left atrial (LA) radiofrequency delivery correlated with percent LA scarring by DE-MRI (r = 0.6, P < 0.001). Based on DE patterns, complete encirclement was seen in only 131 of 335 PVs (39.1%). As expected, Cox regression analysis showed a significant relationship between the number of veins encircled by delayed enhancement and clinical success (hazard ratio of 0.62, P = 0.015). Also, progressive quartile increases in postablation posterior and septal wall scarring reduced recurrences rates with a HR of 0.65, P = 0.022 and 0.66, P = 0.026, respectively. CONCLUSION: Pathologic remodeling in the septal and posterior walls of the LA helps form the pathogenic substrate for AF, and these early results suggest that more aggressive treatment of these regions appears to correlate with improved ablation outcomes. Noninvasive imaging to characterize tissue changes after ablation may prove essential to stratifying recurrence risk.
Authors:
Nathan M Segerson; Marcos Daccarett; Troy J Badger; Akram Shabaan; Nazem Akoum; Eric N Fish; Swati Rao; Nathan S Burgon; Yaw Adjei-Poku; Eugene Kholmovski; Sathya Vijayakumar; Edward V R DiBella; Rob S MacLeod; Nassir F Marrouche
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-10-05
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  126-32     Citation Subset:  IM    
Affiliation:
University of Utah Atrial Fibrillation Program, Department of Internal Medicine, University of Utah Hospitals & Clinics, Salt Lake City, Utah, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / diagnosis*,  surgery*
Catheter Ablation / methods*
Female
Heart Atria / pathology,  surgery*
Heart Conduction System / pathology,  surgery*
Heart Septum / pathology,  surgery*
Humans
Magnetic Resonance Imaging*
Male
Pilot Projects
Treatment Outcome
Grant Support
ID/Acronym/Agency:
5T32HL007576/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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