The Impact of the Atrial Wall Thickness in Normal/mild Late-gadolinium Enhancement Areas on Atrial Fibrillation Rotors in Persistent Atrial Fibrillation Patients

Overview

Journal J Arrhythm

Publisher Wiley

Date 2022 Apr 7

PMID 35387140

Authors

Toshihiro Nakamura

Kunihiko Kiuchi

Koji Fukuzawa

Mitsuru Takami

Yoshiaki Watanabe

Yu Izawa

Makoto Takemoto

Jun Sakai

Atsusuke Yatomi

Yusuke Sonoda

Hiroyuki Takahara

Kazutaka Nakasone

Kyoko Yamamoto

Yuya Suzuki

Ken-Ichi Tani

Noriyuki Negi

Atsushi Kono

Takashi Ashihara

Ken-Ichi Hirata

Affiliations

Soon will be listed here.

Abstract

Background: Some of atrial fibrillation (AF) drivers are found in normal/mild late-gadolinium enhancement (LGE) areas, as well as moderate ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans.

Objective: The purpose of this study was to evaluate the impact of the AWT in normal/mild LGE areas on AF drivers.

Methods: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non-passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real-time phase mapping (ExTRa Mapping), mild LGE areas were defined as areas with a volume ratio of the enhancement voxel of 0% to <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE-MRI.

Results: NPAs were found in 20 (18.0%) of 131 normal/mild LGE areas where AWT was significantly thicker than that in the passively activated areas (PAs) (2.5 ± 0.3 vs. 2.2 ± 0.3 mm, < .001). However, NPAs were found in 41 (26.3%) of 156 moderate LGE areas where AWT was thinner than that of PAs (2.1 ± 0.2 mm vs. 2.23 ± 0.3 mm, = .02). An ROC curve analysis yielded an optimal cutoff value of 2.2 mm for predicting the presence of an NPA in normal/mild LGE areas.

Conclusion: The location of AF drivers in normal/mild LGE areas might be more accurately identified by evaluating AWT.

Citing Articles

Chamber-specific wall thickness features in human atrial fibrillation.

Zhao J, Kennelly J, Nalar A, Kulathilaka A, Sharma R, Bai J Interface Focus. 2023; 13(6):20230044.

PMID: 38106912 PMC: 10722209. DOI: 10.1098/rsfs.2023.0044.

Distributions and number of drivers on real-time phase mapping associated with successful atrial fibrillation termination during catheter ablation for non-paroxysmal atrial fibrillation.

Riku S, Inden Y, Yanagisawa S, Fujii A, Tomomatsu T, Nakagomi T J Interv Card Electrophysiol. 2023; 67(2):303-317.

PMID: 37354370 DOI: 10.1007/s10840-023-01588-8.

The impact of the atrial wall thickness in normal/mild late-gadolinium enhancement areas on atrial fibrillation rotors in persistent atrial fibrillation patients.

Nakamura T, Kiuchi K, Fukuzawa K, Takami M, Watanabe Y, Izawa Y J Arrhythm. 2022; 38(2):221-231.

PMID: 35387140 PMC: 8977582. DOI: 10.1002/joa3.12676.

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