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Lesion Delivery and Scar Formation in Catheter Ablation for Atrial Fibrillation The DECAAF II Trial.
Akoum, Nazem; Mekhael, Mario; Bisbal, Felipe; Wazni, Oussama; McGann, Christopher; Lee, Hyejung; Bardsley, Tyler; Greene, Tom; Dean, J Michael; Dagher, Lilas; Kholmovski, Eugene; Mansour, Moussa; Marchlinski, Francis; Wilber, David; Hindricks, Gerhard; Mahnkopf, Christian; Wells, Darryl; Jaïs, Pierre; Sanders, Prashanthan; Brachmann, Johannes; Bax, Jeroen J; de Boer, Leonie Morrison-; Deneke, Thomas; Calkins, Hugh; Sohns, Christian; Marrouche, Nassir.
Afiliación
  • Akoum N; Cardiology Department, University of Washington Medical Center, Seattle, WA, United States.
  • Mekhael M; Cardiology Department, Tulane University School of Medicine, New Orleans, LA, United States.
  • Bisbal F; Heart Institute, University Hospital Germans Trias i Pujol, Barcelona, Spain.
  • Wazni O; Cleveland Clinic, Cleveland, OH, United States.
  • McGann C; Swedish Heart Center, Seattle, Washington, United States.
  • Lee H; University of Utah, Salt Lake City, UT, United States.
  • Bardsley T; University of Utah, Salt Lake City, UT, United States.
  • Greene T; University of Utah, Salt Lake City, UT, United States.
  • Dean JM; University of Utah, Salt Lake City, UT, United States.
  • Dagher L; Cardiology Department, Tulane University School of Medicine, New Orleans, LA, United States.
  • Kholmovski E; Cardiology Department, Johns Hopkins Medicine, Baltimore, MD, United States.
  • Mansour M; Cardiology Department, Massachusetts General Hospital, Boston, MA, United States.
  • Marchlinski F; Cardiology Department, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
  • Wilber D; Cardiology Department, Loyola University Chicago, Chicago, IL, United States.
  • Hindricks G; Cardiology Department, Leipzig University, Leipzig, Germany.
  • Mahnkopf C; Klinikum Coburg, Coburg, Germany.
  • Wells D; Swedish Heart Center, Seattle, Washington, United States.
  • Jaïs P; Cardiology Department, Segalen University, Bordeaux, France.
  • Sanders P; Cardiology Department, Adelaide Medical School, Adelaide, Australia.
  • Brachmann J; Klinikum Coburg, Coburg, Germany.
  • Bax JJ; Cardiology Department, Leiden University Medical Center, Leiden, Netherlands and Cardiology Department, Turku Heart Center, Turku, Finland.
  • de Boer LM; University of Utah, Salt Lake City, UT, United States.
  • Deneke T; Heart Center Bad Neustadt, Bad Neustadt, Germany.
  • Calkins H; Swedish Heart Center, Seattle, Washington, United States.
  • Sohns C; Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
  • Marrouche N; Cardiology Department, Tulane University School of Medicine, New Orleans, LA, United States. Electronic address: nmarrouche@tulane.edu.
Heart Rhythm ; 2024 Sep 06.
Article en En | MEDLINE | ID: mdl-39245248
ABSTRACT

BACKGROUND:

The DECAAF-II randomized trial showed no difference in AF recurrence with additional delayed enhancement MRI (DE-MRI) fibrosis-targeted ablation to pulmonary vein isolation (PVI) in persistent AF.

OBJECTIVES:

We evaluated the impact of lesion delivery on ablation-induced scarring and AF recurrence.

METHODS:

Lesions delivered, targeting fibrotic and non-fibrotic areas identified from pre-ablation DE-MRI, were studied in relation to ablation-induced scarring on 3-months DE-MRI, including their association with arrhythmia recurrence.

RESULTS:

593 patients, treated with radiofrequency were analyzed 293 underwent PVI and 300 underwent additional fibrosis-guided ablation. Lesion analysis showed that 80.9% in the MRI fibrosis-guided group vs 16.5% in the PVI group (p<0.001), had ≥ 40% of baseline fibrosis targeted. MRI assessment of ablation-induced scar showed that 44.8% of fibrosis-guided ablation and 15.5% of PVI had ≥ 40% of their fibrosis covered by scar (P<0.001), demonstrating a significant attenuation from lesions delivered to scar formed. In the overall population, fibrosis coverage with scar was not associated with recurrence (HR 0.90, 95% confidence interval [CI] 0.80-1.01, p = 0.08 per 20% increase). In patients with baseline fibrosis <20%, fibrosis coverage with scar was associated with lower recurrence than PVI (HR 0.85; 95% CI [0.73-0.97]; p=0.03), whereas the association was not significant when baseline fibrosis ≥20% (HR 0.97; [0.80-1.17], p=0.77). Significant center variation was observed in fibrosis targeting and coverage with scarring.

CONCLUSIONS:

Radiofrequency ablation lesions do not uniformly result in scar formation. Post hoc analysis suggests reduced arrhythmia recurrence when ablation-induced scarring covers fibrotic regions in patients with low baseline fibrosis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Heart Rhythm Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Heart Rhythm Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos