Spatial Distribution of LGE of LA MRI in Atrial Fibrillation

Jan 24, 2018
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Authors:
Higuchi K, Cates J, Gardner G, et al.
Citation:
The Spatial Distribution of Late Gadolinium Enhancement of Left Atrial Magnetic Resonance Imaging in Patients With Atrial Fibrillation. JACC Clin Electrophysiol 2018;4:49-58.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the spatial distribution of late gadolinium enhancement (LGE) of the left atrium (LA) by LGE-magnetic resonance imaging (MRI) in an atrial fibrillation (AF) population?

Methods:

The investigators evaluated 160 patients with AF (mean age 66 ± 11 years) with LGE-MRI scans before AF ablation. To know the spatial distribution of LGE, the extent of LGE in six LA subregions was examined. Overall LGE distribution was also summarized as a spatial frequency histogram using an atlas of LA shape. These data were also compared between paroxysmal AF (87 patients) and persistent AF (73 patients). Kaplan-Meier analysis was used for graphical assessment of time-related recurrences after single AF ablation.

Results:

LGE coverage (%) in each subregion was as follows: 41.8 ± 18.9% in the left pulmonary vein (PV) antrum, 27.1 ± 16.7% in the left lateral wall, 25.8 ± 15.3% in the posterior wall, 19.7 ± 15.3% in the anterior wall, 17.1 ± 15.0% in the right PV antrum, and 12.0 ± 13.2% in the septum wall. LGE was heterogeneously distributed in the LA and was found with the highest frequency in the posterior wall near the inferior left PV antrum by the LGE histogram. A comparison of paroxysmal AF with persistent AF suggests that LGE was more expected in persistent AF compared with paroxysmal AF, particularly with a spread on the posterior and the anterior wall.

Conclusions:

The authors concluded that LGE in the LA was heterogeneously distributed.

Perspective:

This study reports that LGE was heterogeneously distributed in the LA when analyzed from LGE-MRI, and regions with high LGE coverage were the left PV antrum, the left lateral wall, and the posterior wall, which can be seen on the histogram of LGE distribution, even at the paroxysmal AF stage. Furthermore, LGE spreads on the posterior LA wall and occurs on the anterior LA wall in persistent AF, and overall LGE coverage was significantly greater in persistent AF than paroxysmal AF. The site-specific LGE appearance using LGE-MRI before AF ablation may help modify the LA remodeling site together with PV isolation.

Keywords: Ablation Techniques, Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Atrial Remodeling, Catheter Ablation, Diagnostic Imaging, Gadolinium, Heart Atria, Magnetic Resonance Imaging, Pulmonary Veins


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