Association of left atrial pressure with late gadolinium enhancement extent in patient who underwent catheter ablation for atrial fibrillation

• Published in: Scientific reports Vol. 10; no. 1; pp. 16486 - 9
• Main Authors: Roh, Seung-Young, Lee, Dae In, Hwang, Sung Ho, Lee, Kwang-No, Baek, Yong-soo, Iqbal, Mohammad, Kim, Dong-Hyeok, Ahn, Jinhee, Shim, Jaemin, Choi, Jong-Il, Kim, Young-Hoon
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05.10.2020; Nature Publishing Group; Nature Portfolio
• Subjects: 631/1647/245/1628; 692/4019; 692/4019/2776; 692/699/75/29; Ablation; Arrhythmia; Atrial Fibrillation - metabolism; Atrial Fibrillation - physiopathology; Atrial Pressure - physiology; Atrial Remodeling - physiology; Brain natriuretic peptide; Cardiac arrhythmia; Catheter Ablation - methods; Catheters; Congestive heart failure; Contrast Media - metabolism; Female; Fibrillation; Fibrosis; Fibrosis - metabolism; Fibrosis - physiopathology; Gadolinium; Gadolinium - metabolism; Heart Atria - metabolism; Heart Atria - physiopathology; Heart Failure - metabolism; Heart Failure - physiopathology; Humanities and Social Sciences; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical instruments; Middle Aged; multidisciplinary; Patients; Pressure; Prospective Studies; Radiofrequency ablation; Science; Science (multidisciplinary)
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-72929-0

Atrial remodeling with fibrosis has been well-described in patients with atrial fibrillation (AF). We hypothesized that the left atrial (LA)-late gadolinium enhancement (LGE) extent on cardiac magnetic resonance (CMR) imaging is associated with LA pressure and can be a marker for suitable candidates for non-paroxysmal AF ablation. A total of 173 AF patients with an LA-LGE area on CMR imaging were enrolled. The clinical parameters, including invasively measured LA pressure, were compared between the patients with extensive LA-LGE (E-LGE, LGE extent ≥ 20%, n = 78) and those with small LA-LGE (S-LGE, LGE extent < 20%, n = 95). The E-LGE group had higher peak LA pressures than the S-LGE group (23 versus 19 mmHg, p < 0.001). The E-LGE group had more patients with non-paroxysmal AF (non-PAF) (51% vs. 34%), heart failure (9% vs. 0%), and higher NT pro-B-type natriuretic peptide (472 vs. 265 pg/ml) (all p < 0.05). LA pressure ≥ 21 mmHg was an independent predictor of E-LGE (OR = 2.218; p = 0.019). In the paroxysmal AF (PAF) subgroup, freedom from atrial arrhythmia after catheter ablation was not different (81% vs 86%, log-rank p = 0.529). However, in the non-PAF subgroup, it was significantly higher in the S-LGE group than in the E-LGE group (81% vs 55%, log-rank p = 0.014). Increased LA pressure was related to the LA-LGE extent. LA-LGE was a good predictor of outcome after catheter ablation, but only in patients with non-PAF.