Investig Magn Reson Imaging.  2022 Sep;26(3):151-160. 10.13104/imri.2022.26.3.151.

Left Ventricular Remodeling After Catheter Ablation of Atrial Fibrillation: Changes of Myocardial Extracellular Volume Fraction by Cardiac MRI

• Kim SU
• Park S
• Cho H
• Cho Y
• Oh YW
• Kim YG
• Shim J
• Choi Ji
• Kim YH
• Paek MY
• Hwang SH

• KMID: 2533883
• DOI: http://doi.org/10.13104/imri.2022.26.3.151

Abstract

Purpose
The aim of this study is to demonstrate the association between recurrent atrial fibrillation (AF) and left ventricular (LV) adverse remodeling after catheter ablation and to evaluate the change of myocardial extracellular volume fraction (ECV) by catheter ablation outcomes.
Materials and Methods
We retrospectively recruited 60 patients (44 men and 16 women) with a median age of 57 years (range, 32–78 years) who underwent cardiac MRI before and at 6–12 months after catheter ablation of AF. Cardiac MRI quantified myocardial ECV (%) in the left ventricle. Depending on myocardial ECV after catheter ablation, patients were divided into two groups: 1) LV adverse remodeling with ECV ≥ 28%; and 2) no adverse LV remodeling with ECV < 28%. Multivariable analysis was performed to assess the association between recurrent AF and LV remodeling.
Results
Of 60 patients, 21 (35%) were in the LV adverse remodeling group (mean ECV ± standard deviation [SD]: 29.8% ± 1.4%) and 39 (65%) were in the no adverse LV remodeling group (mean ECV ± SD: 24.7% ± 1.5%). The incidence of recurrent AF was significantly greater in the LV adverse remodeling group than in the no adverse LV remodeling group (81% vs. 13%, p < 0.001). In patients with recurrent AF, mean myocardial ECV significantly increased from 27.7% ± 2.3% to 29.2% ± 2.3% (p = 0.004) after catheter ablation. In a multivariable analysis after adjusting sex, age, and myocardial ECV before catheter ablation, recurrent AF was independently associated with LV adverse remodeling after catheter ablation (odds ratio: 28.9, 95% confidence interval: 6.8–121.7, p < 0.001).
Conclusion
When monitoring with cardiac MRI, sustained AF was significantly associated with LV adverse remodeling through an increase in myocardial ECV after catheter ablation of AF.

Keyword

Atrial fibrillation; Catheter ablation; Left ventricle; Magnetic resonance imaging; Myocardium