Atrial Fibrosis Quantified Using Late Gadolinium Enhancement MRI is Associated With Sinus Node Dysfunction Requiring Pacemaker Implant

作者：Akoum Nazem^*; Mcgann Christopher; Vergara Gaston; Badger Troy; Ranjan Ravi; Mahnkopf Christian; Kholmovski Eugene; Macleod Rob; Marrouche Nassir

来源：Journal of Cardiovascular Electrophysiology, 2012, 23(1): 44-50.

DOI：10.1111/j.1540-8167.2011.02140.x

• atrial fibrillation
• catheter ablation
• magnetic resonance imaging
• pacemaker
• sinus node dysfunction

Atrial Fibrosis and Sinus Node Dysfunction. Introduction: Sinus node dysSND) commonly manifests with atrial arrhythmias alternating with sinus pauses and sinus bradycardia. The underlying process is thought to be because of atrial fibrosis. We assessed the value of atrial fibrosis, quantified using Late Gadolinium Enhanced-MRI (LGE-MRI), in predicting significant SND requiring pacemaker implant.
Methods: Three hundred forty-four patients with atrial fibrillation (AF) presenting for catheter ablation underwent LGE-MRI. Left atrial (LA) fibrosis was quantified in all patients and right atrial (RA) fibrosis in 134 patients. All patients underwent catheter ablation with pulmonary vein isolation with posterior wall and septal debulking. Patients were followed prospectively for 329 +/- 245 days. Ambulatory monitoring was instituted every 3months. Symptomatic pauses and bradycardia were treated with pacemaker implantation per published guidelines.
Results: The average patient age was 65 +/- 12 years. The average wall fibrosis was 16.7 +/- 11.1% in the LA, and 5.3 +/- 6.4% in the RA. RA fibrosis was correlated with LA fibrosis (R-2 = 0.26; P < 0.01). Patients were divided into 4 stages of LA fibrosis (Utah I: < 5%, Utah II: 5-20%, Utah III: 20-35%, Utah IV: > 35%). Twenty-two patients (mean atrial fibrosis, 23.9%) required pacemaker implantation during follow-up. Univariate and multivariate analysis identified LA fibrosis stage (OR, 2.2) as a significant predictor for pacemaker implantation with an area under the curve of 0.704.
Conclusions: In patients with AF presenting for catheter ablation, LGE-MRI quantification of atrial fibrosis demonstrates preferential LA involvement. Significant atrial fibrosis is associated with clinically significant SND requiring pacemaker implantation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 44-50, January 2012)

• 出版日期2012-1