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Intra-arterial dyssynchrony predicts failure of catheter ablation for AF
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Among patients who underwent cardiac MRI while in sinus rhythm before catheter ablation for atrial fibrillation, intra-arterial dyssynchrony predicted recurrence of AF after the procedure, researchers reported.
“In our study, we found that the best indicator of success is how in sync the left atrium chamber of the heart is when it relaxes,” Luisa Ciuffo, MD, a postdoctoral fellow in the division of cardiology at Johns Hopkins University School of Medicine, said in a press release. “Diseased, damaged hearts with a lot of scar tissue don’t contract and relax at the same time throughout the atrium because it is more difficult to rhythmically contract the thicker, tougher, damaged tissue.”
According to the study background, catheter ablation for AF is associated with a high rate of recurrence, which may be driven by poor patient selection.
Ciuffo and colleagues analyzed 208 patients with AF (mean age, 59 years; 72% men; 26% with nonparoxysmal AF) who underwent cardiac MRI in sinus rhythm before their catheter ablation.
The outcome of interest was intra-arterial dyssynchrony, defined as the standard deviation of the time to peak longitudinal strain corrected by cycle length.
At a mean-follow-up of 20 months, AF recurred in 101 patients and did not recur in 107 patients.
Patients with AF recurrence had a higher standard deviation-time to peak strain than those without recurrence (3.9% vs. 2.2%; P < .001), according to the researchers.
After adjustment for clinical risk factors, AF type, left atrial structure and function and fibrosis, standard deviation-time to peak strain remained associated with AF recurrence (P < .001), Ciuffo and colleagues wrote.
When patients were stratified by percentage of intra-arterial dyssynchrony in the left atrium (< 2.86% vs. > 2.86%), those with intra-arterial dyssynchrony in the left atrium greater than 2.86% had a higher rate of AF recurrence (P < .001).
Adding intra-arterial dyssynchrony to the CAAP-AF risk score improved prediction of AF recurrence after ablation. Compared with the old risk score, the new risk score had a higher OR (1.97 vs. 1.44) and a higher C-statistic (0.77 vs. 0.68; P = .024), according to the researchers.
Intra-arterial dyssynchrony also had better specificity and positive predictive value for AF recurrence after ablation than other indices including left atrial fibrosis and maximum left atrial volume, they wrote. – by Erik Swain
Disclosure: One author reports he has financial ties with Biosense Webster, CardioSolv, Siemens and St. Jude Medical.
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