Author + information
- Received May 11, 2016
- Revision received July 5, 2017
- Accepted July 6, 2017
- Published online January 15, 2018.
- Hubert Cochet, MD, PhDa,b,∗ (, )
- Rémi Dubois, PhDb,
- Seigo Yamashita, MDa,
- Nora Al Jefairi, MDa,
- Benjamin Berte, MDa,
- Jean-Marc Sellal, MDa,
- Darren Hooks, MDa,
- Antonio Frontera, MDa,
- Sana Amraoui, MDa,b,
- Adlane Zemoura, MDa,b,
- Arnaud Denis, MDa,b,
- Nicolas Derval, MDa,b,
- Frederic Sacher, MD, PhDa,b,
- Olivier Corneloup, MDa,
- Valérie Latrabe, MDa,
- Stéphanie Clément-Guinaudeau, MDa,
- Jatin Relan, PhDc,
- Sohail Zahid, PhDd,
- Patrick M. Boyle, PhDd,
- Natalia A. Trayanova, PhDd,
- Olivier Bernus, PhDb,
- Michel Montaudon, MD, PhDa,b,
- François Laurent, MDa,b,
- Mélèze Hocini, MDa,b,
- Michel Haïssaguerre, MDa,b and
- Pierre Jaïs, MDa,b
- aHaut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- bNational Institute for Health and Medical Research (INSERM) U1045 – Electrophysiology and Heart Modeling Institute, Bordeaux, France
- cSt. Jude Medical, St. Paul, Minnesota
- dInstitute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Hubert Cochet, Unité d’Imagerie Thoracique et Cardiovasculaire, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France.
Objectives This study sought to assess the relationship between fibrosis and re-entrant activity in persistent atrial fibrillation (AF).
Background The mechanisms involved in sustaining re-entrant activity during AF are poorly understood.
Methods Forty-one patients with persistent AF (age 56 ± 12 years; 6 women) were evaluated. High-resolution electrocardiographic imaging (ECGI) was performed during AF by using a 252-chest electrode array, and phase mapping was applied to locate re-entrant activity. Sites of high re-entrant activity were defined as re-entrant regions. Late gadolinium-enhanced (LGE) cardiac magnetic resonance (CMR) was performed at 1.25 × 1.25 × 2.5 mm resolution to characterize atrial fibrosis and measure atrial volumes. The relationship between LGE burden and the number of re-entrant regions was analyzed. Local LGE density was computed and characterized at re-entrant sites. All patients underwent catheter ablation targeting re-entrant regions, the procedural endpoint being AF termination. Clinical, CMR, and ECGI predictors of acute procedural success were then analyzed.
Results Left atrial (LA) LGE burden was 22.1 ± 5.9% of the wall, and LA volume was 74 ± 21 ml/m2. The number of re-entrant regions was 4.3 ± 1.7 per patient. LA LGE imaging was significantly associated with the number of re-entrant regions (R = 0.52; p = 0.001), LA volume (R = 0.62; p < 0.0001), and AF duration (R = 0.54; p = 0.0007). Regional analysis demonstrated a clustering of re-entrant activity at LGE borders. Areas with high re-entrant activity showed higher local LGE density as compared with the remaining atrial areas (p < 0.0001). Failure to achieve AF termination during ablation was associated with higher LA LGE burden (p < 0.001), higher number of re-entrant regions (p < 0.001), and longer AF duration (p = 0.008).
Conclusions The number of re-entrant regions during AF relates to the extent of LGE on CMR, with the location of these regions clustering to LGE areas. These characteristics affect procedural outcomes of ablation.
- atrial fibrillation
- atrial fibrosis
- electrocardiographic mapping
- magnetic resonance imaging
The research leading to these results received funding from l’Agence Nationale de la Recherche (ANR) under Grant Agreements Equipex MUSIC ANR-11-EQPX-0030, TEMPO ANR-12-BSV1-029, and IHU LIRYC ANR-10-IAHU-04; from the European Union Seventh Framework Programme (FP7/2007-2013) under Grant Agreement HEALTH-F2-2010-261057; and from the National Institutes of Health (Pioneer Award DP1HL123271 to Dr. Trayanova). Drs. Haïssaguerre, Hocini, and Jaïs are stockowners in CardioInsight, Inc. Dr. Dubois is a paid consultant for and has received royalties from CardioInsight, Inc. Dr. Relan is an employee of St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 11, 2016.
- Revision received July 5, 2017.
- Accepted July 6, 2017.
- 2018 American College of Cardiology Foundation
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