Abstract
BackgroundUsing cardiovascular magnetic resonance imaging (CMR), it is possible to detect diffuse fibrosis of the left ventricle (LV) in patients with atrial fibrillation (AF), which may be independently associated with recurrence of AF after ablation. By conducting CMR, clinical, electrophysiology and biomarker assessment we planned to investigate LV myocardial fibrosis in patients undergoing AF ablation.MethodsLV fibrosis was assessed by T1 mapping in 31 patients undergoing percutaneous ablation for AF. Galectin-3, coronary sinus type I collagen C terminal telopeptide (ICTP), and type III procollagen N terminal peptide were measured with ELISA. Comparison was made between groups above and below the median for LV extracellular volume fraction (ECV), followed by regression analysis.ResultsOn linear regression analysis LV ECV had significant associations with invasive left atrial pressure (Beta 0.49, P = 0.008) and coronary sinus ICTP (Beta 0.75, P < 0.001), which remained significant on multivariable regression.ConclusionLV fibrosis in patients with AF is associated with left atrial pressure and invasively measured levels of ICTP turnover biomarker.
Highlights
Using cardiovascular magnetic resonance imaging (CMR), it is possible to detect diffuse fibrosis of the left ventricle (LV) in patients with atrial fibrillation (AF), which may be independently associated with recurrence of AF after ablation
Fibrosis is a hallmark of the left atrial (LA) pathological changes associated with AF development and recurrence
We investigated the interaction between LV fibrosis, LA fibrosis, and LA pressure, all of which have been associated with arrhythmia recurrence in patients after AF ablation
Summary
Using cardiovascular magnetic resonance imaging (CMR), it is possible to detect diffuse fibrosis of the left ventricle (LV) in patients with atrial fibrillation (AF), which may be independently associated with recurrence of AF after ablation. Percutaneous pulmonary vein (PV) isolation is often used for rhythm control in patients with atrial fibrillation (AF). At least one third of such patients experience a recurrence of AF even after multiple procedures [1]. This is most commonly due to reconnection of the pulmonary veins, in a significant proportion of patients this is not the case and the mechanism(s) in these instances is unclear. Diffuse LV fibrosis can be estimated using cardiovascular magnetic resonance (CMR), by calculating the extracellular volume fraction (ECV) from native and post contrast T1 mapping [9]
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