Title:Prediction of Recurrence of Atrial Fibrillation Post-ablation Based on
Atrial Fibrosis Seen on Late Gadolinium Enhancement MRI: A Metaanalysis
Volume: 19
Issue: 3
Author(s): Manjari Rani Regmi*, Mukul Bhattarai, Priyanka Parajuli, Albert Botchway, Nitin Tandan, Jumana Abdelkarim and Mohamed Labedi
Affiliation:
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, Ill, USA
Keywords:
AF ablation, LGE, MRI, left atrium, fibrosis, recurrence.
Abstract:
Objectives: This meta-analysis aims to investigate the recurrence of atrial fibrillation
(AF) post-ablation based on the various stages of fibrosis seen in the late gadolinium enhancement
magnetic resonance imaging (LGE-MRI).
Methods: Electronic databases were searched using specific terms and identified nine studies that
met the inclusion criteria. A total of 1,787 patients underwent LGE-MRI to assess atrial fibrosis
before catheter ablation for AF. We performed three analyses: first, we compared stage IV versus
stage I (reference group). The second set examined the combined stages III and IV versus stages I
and II (reference group). The third set compared stage IV versus combined stages I, II, and III. The
metanalysis relied on a random-effects model to pool the odds ratios (OR) and 95% confidence intervals
(CI) using the DerSimonian and Laird method. The data was analyzed using StatsDirect
software in England.
Results: The study showed a higher rate of AF recurrence after ablation in stage IV atrial fibrosis
than in stage I (OR, 9.54; 95% CI, 3.81 to 28.89; P<00001). Also, in patients with combined stages
III & IV of atrial fibrosis, AF recurrence was significantly higher after ablation than in stages I &
II groups (OR, 2.37; 95% CI, 1.61 to 3.50; P<00001). Similarly, compared to combined stages I,
II, and III, patients with stage IV have higher odds of recurrence post-ablation (OR, 4.24; 95% CI,
2.39- 7.52, P < 0.001).
Conclusion: This metanalysis demonstrates the strong association between left atrial fibrosis in
LGE-MRI and AF post-ablation recurrence. The finding of this study will further assist clinicians
in predicting the recurrence rate of AF based on the amount of fibrosis and tailor therapeutic decisions
for further management.
