Left atrial (LA) volumes are related to success of atrial fibrillation (AF) ablation,
but the relation to other functional and structural parameters is less well understood.
Our goal was to detect potential functional and structural predictors of arrhythmia
recurrence after ablation using cardiac magnetic resonance imaging (CMRi) and to non-invasively
assess the relation between LA functional and structural remodeling pre- and post-ablation.A
total of 55 patients (38 male, age 67 ± 10 years) underwent CMRi prior to and then
within 24-h and 3-months after ablation. LA volumes (LAV) and function (as assessed
by ejection fraction and peak longitudinal atrial strain (PLAS)) were measured by
feature-tracking CMRi, and LA fibrosis/scarring was quantified using late‑gadolinium
enhancement (LGE) imaging.Atrial function was lower acutely in patients with recurrence
versus those with non-recurrence: [R vs NR: EFTotal 27.8 ± 10.3% vs 38.1 ± 11% p =
0.002; EFActive 10.5 ± 8% vs 19.1 ± 12% p = 0.007; EFPassive 19.4 ± 8 vs 25.8 ± 10
p = 0.021; PLAS 13 ± 5.9% vs 20.2 ± 7% p = 0.004]. With univariate analysis, baseline
minimum volume (MinLAV, MinLAVi), several baseline functional parameters (EFTotal,
EFPassive, EFActive, PLAS), and LA-LGE were predictors of recurrence [all p < 0.05].
Acute function (EFTotal, EFPassive, EFActive, PLAS) also predicted recurrence (p <
0.01). Lower pre-ablation EFTotal, EFPassive, and PLAS correlated with higher amount
of pre-ablation LA-LGE (p < 0.05). In a multivariate model including MinLAV, EFActive
and LA-LGE (all at baseline), LA-LGE was the only independent predictor of recurrence
(p = 0.0322).Pre-ablation function inversely correlated with LA-LGE and was related
to success of AF ablation. Multi-parametric and longitudinal assessment of LA function
and structure could be helpful in selection of optimal treatment strategies for AF
patients by predicting outcomes.
