Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence
Background: Prior studies evaluating post-atrial fibrillation (AF) ablation pulmonary vein (PV) ostial gaps via magnetic resonance imaging (MRI) have shown circumferential PV fibrosis in a minority of patients, and their correlation with AF recurrence was weak. These studies were mostly based on rad...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/6/2442 |
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| author | Moshe Rav Acha Oholi Tovia-Brodie Yoav Michowitz Feras Bayya Fauzi F. Shaheen Shalom Abuhatzera Aharon Medina Michael Glikson Arik Wolak |
| author_facet | Moshe Rav Acha Oholi Tovia-Brodie Yoav Michowitz Feras Bayya Fauzi F. Shaheen Shalom Abuhatzera Aharon Medina Michael Glikson Arik Wolak |
| author_sort | Moshe Rav Acha |
| collection | DOAJ |
| description | Background: Prior studies evaluating post-atrial fibrillation (AF) ablation pulmonary vein (PV) ostial gaps via magnetic resonance imaging (MRI) have shown circumferential PV fibrosis in a minority of patients, and their correlation with AF recurrence was weak. These studies were mostly based on radio-frequency AF ablations. Aim: We aimed to assess cryoballoon ablation-induced PV fibrosis via MRI and its correlation with AF recurrence. Methods and Results: This was a prospective study of consecutive patients with symptomatic AF who underwent pre- and post-ablation MRI to assess baseline and ablation-induced fibrosis, respectively. Post-ablation PV gaps were assessed by new semi-quantitative visual analysis assisted by computerized ADAS analysis. AF recurrence monitored via multiple ECGs and event monitoring at 6 and 12 months post ablation. Nineteen patients with 80 PVs were included, age 56 ± 11, with paroxysmal and persistent AF in 17/19 and 2/19 patients, respectively. Baseline MRI showed minimal LA fibrosis. All patients underwent successful cryoballoon PV electrical isolation. Post-ablation MRI revealed circumferential PV fibrosis among 63/80 (78.8%) PVs and partial fibrosis with major gaps among 17/80 (21.2%) PVs. AF recurred within one year in 5/9 (55.5%) patients with partial PV fibrosis, while no AF recurred among the 10 patients in whom all PVs had circumferential fibrosis (<i>p</i> < 0.01). Similarly, there were significantly more PVs without circumferential fibrosis (due to major gaps) among patients with AF recurrence as compared with patients without AF recurrence (42.9% vs. 13.5%; <i>p</i> < 0.01). Conclusion: Cryoballoon AF ablation results in circumferential PV fibrosis in the majority of PVs, as assessed by a new clinically relevant MRI-LGE analysis. Significant correlation was found between major PV gaps on post-ablation MRI and AF recurrence, suggesting that MRI might have the ability to predict AF recurrence. |
| first_indexed | 2024-03-11T06:21:46Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T06:21:46Z |
| publishDate | 2023-03-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-1573f68f9cf64599bdc30541117f5cf52023-11-17T11:52:55ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01126244210.3390/jcm12062442Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation RecurrenceMoshe Rav Acha0Oholi Tovia-Brodie1Yoav Michowitz2Feras Bayya3Fauzi F. Shaheen4Shalom Abuhatzera5Aharon Medina6Michael Glikson7Arik Wolak8Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelJesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelJesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelJesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelJesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelJesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelShamir Medical Center, Cardiology Department, Be’er-Yaakov 7033001, IsraelJesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelJesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, IsraelBackground: Prior studies evaluating post-atrial fibrillation (AF) ablation pulmonary vein (PV) ostial gaps via magnetic resonance imaging (MRI) have shown circumferential PV fibrosis in a minority of patients, and their correlation with AF recurrence was weak. These studies were mostly based on radio-frequency AF ablations. Aim: We aimed to assess cryoballoon ablation-induced PV fibrosis via MRI and its correlation with AF recurrence. Methods and Results: This was a prospective study of consecutive patients with symptomatic AF who underwent pre- and post-ablation MRI to assess baseline and ablation-induced fibrosis, respectively. Post-ablation PV gaps were assessed by new semi-quantitative visual analysis assisted by computerized ADAS analysis. AF recurrence monitored via multiple ECGs and event monitoring at 6 and 12 months post ablation. Nineteen patients with 80 PVs were included, age 56 ± 11, with paroxysmal and persistent AF in 17/19 and 2/19 patients, respectively. Baseline MRI showed minimal LA fibrosis. All patients underwent successful cryoballoon PV electrical isolation. Post-ablation MRI revealed circumferential PV fibrosis among 63/80 (78.8%) PVs and partial fibrosis with major gaps among 17/80 (21.2%) PVs. AF recurred within one year in 5/9 (55.5%) patients with partial PV fibrosis, while no AF recurred among the 10 patients in whom all PVs had circumferential fibrosis (<i>p</i> < 0.01). Similarly, there were significantly more PVs without circumferential fibrosis (due to major gaps) among patients with AF recurrence as compared with patients without AF recurrence (42.9% vs. 13.5%; <i>p</i> < 0.01). Conclusion: Cryoballoon AF ablation results in circumferential PV fibrosis in the majority of PVs, as assessed by a new clinically relevant MRI-LGE analysis. Significant correlation was found between major PV gaps on post-ablation MRI and AF recurrence, suggesting that MRI might have the ability to predict AF recurrence.https://www.mdpi.com/2077-0383/12/6/2442MRIcryoballoonablation-inducedfibrosisAFrecurrence |
| spellingShingle | Moshe Rav Acha Oholi Tovia-Brodie Yoav Michowitz Feras Bayya Fauzi F. Shaheen Shalom Abuhatzera Aharon Medina Michael Glikson Arik Wolak Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence Journal of Clinical Medicine MRI cryoballoon ablation-induced fibrosis AF recurrence |
| title | Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence |
| title_full | Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence |
| title_fullStr | Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence |
| title_full_unstemmed | Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence |
| title_short | Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence |
| title_sort | cryoballoon induced circumferential pulmonary vein fibrosis assessed by late gadolinium enhancement cardiac magnetic resonance imaging and its correlation with clinical atrial fibrillation recurrence |
| topic | MRI cryoballoon ablation-induced fibrosis AF recurrence |
| url | https://www.mdpi.com/2077-0383/12/6/2442 |
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