Abstract
Purpose of the Study: Left atrial (LA) late gadolinium enhancement (LGE) CMR has been proposed to guide ablation therapy and predict procedure outcome. AF electrical and structural remodeling are known to occur to varying extents in patients with AF. The extent to which pre-procedural LGE CMR reflects LA electrophysiological remodeling is unknown. Methods Used: Intracardiac contact mapping during programmed stimulation was used to characterize conduction delay, activation dispersion, electrogram morphology and AF vulnerability in 8 patients undergoing first-time pulmonary vein isolation. Pre-procedural LGE CMR imaging was performed and quantified by LGE signal intensity (SI; image intensity ratio, IIR), % LGE area and LA sphericity indices. Summary of Results: Although electrogram voltage was significantly reduced at areas of high SI (IIR > 0.97 - 0.9mV vs 1.3mV P = 0.049), IIR showed no relationship with electrogram duration (17.7ms vs 18.3ms, P = 0.673), conduction delay (322ms vs 316ms, P = 0.3939) or conduction block (262ms vs. 262ms, P = 0.8667). There was no relationship between % LGE area or sphericity and any of the LA remodeling parameters (all P > 0.05). LA extrastimulus conduction curves showed significant variation between patients with similar LGE CMR findings (Figure).
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