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Linhart M, Alarcon F, Borràs R, Benito EM, Chipa F, Cozzari J, Caixal G, Enomoto N, Carlosena A, Guasch E, Arbelo E, Tolosana JM, Prat-Gonzalez S, Perea RJ, Doltra A, Sitges M, Brugada J, Berruezo A, Mont L. Delayed Gadolinium Enhancement Magnetic Resonance Imaging Detected Anatomic Gap Length in Wide Circumferential Pulmonary Vein Ablation Lesions Is Associated With Recurrence of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006659. [PMID: 30562102 DOI: 10.1161/circep.118.006659] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited knowledge about the impact of anatomic gaps as assessed by delayed gadolinium enhancement cardiac magnetic resonance on atrial fibrillation (AF) recurrence after first pulmonary vein (PV) isolation. METHODS Consecutive patients underwent delayed gadolinium enhancement cardiac magnetic resonance 3 months after radiofrequency circumferential PV isolation. Delayed gadolinium enhancement cardiac magnetic resonance images were assessed from 360 PV resulting in 2880 segments in the 2×8-segment model from 94 patients (52±11 years, 62% paroxysmal AF). Left atria were segmented using dedicated software. Anatomic gap was defined as discontinuation of the ablation line by ≥3 mm. Relative gap length was calculated as absolute gap length divided by the total length of the ablation line. AF recurrence was assessed after a mean follow-up duration of 15±10 months Results: Mean number of anatomic gaps was 5.4 per patient. Recurrence within the first year of ablation was observed in 21 patients with paroxysmal AF (36%) and 19 patients with persistent AF (53%). In the univariate analysis, CHA2DS2-VASc score, AF type, and relative gap length were predictive of recurrence. In the multivariate analysis, only relative gap length was significantly associated with recurrence (hazard ratio, 1.16 [1.02-1.31] per each 10% of gap). CONCLUSIONS The total relative gap length but not the number of anatomic gaps in the PV ablation line as assessed by delayed gadolinium enhancement cardiac magnetic resonance was associated with AF recurrence 1 year after first PV isolation. An increase of 10% relative gap length increased the likelihood of AF recurrence by 16%.
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Affiliation(s)
- Markus Linhart
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Francisco Alarcon
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Roger Borràs
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Eva M Benito
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.)
| | - Fredy Chipa
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Jennifer Cozzari
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Gala Caixal
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Norihiro Enomoto
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Alicia Carlosena
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Eduard Guasch
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Elena Arbelo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Jose Maria Tolosana
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Susana Prat-Gonzalez
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.)
| | - Rosario J Perea
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Adelina Doltra
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Marta Sitges
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Josep Brugada
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Antonio Berruezo
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Lluís Mont
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
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