Nazem Akoum, Mario Mekhael, Felipe Bisbal, Oussama Wazni, Christopher McGann, Hyejung Lee, Tyler Bardsley, Tom Greene, J Michael Dean, Lilas Dagher, Eugene Kholmovski, Moussa Mansour, Francis Marchlinski, David Wilber, Gerhard Hindricks, Christian Mahnkopf, Darryl Wells, Pierre Jaïs, Prashanthan Sanders, Johannes Brachmann, Jeroen J Bax, Leonie Morrison- de Boer, Thomas Deneke, Hugh Calkins, Christian Sohns, Nassir Marrouche
{"title":"Lesion Delivery and Scar Formation in Catheter Ablation for Atrial Fibrillation The DECAAF II Trial.","authors":"Nazem Akoum, Mario Mekhael, Felipe Bisbal, Oussama Wazni, Christopher McGann, Hyejung Lee, Tyler Bardsley, Tom Greene, J Michael Dean, Lilas Dagher, Eugene Kholmovski, Moussa Mansour, Francis Marchlinski, David Wilber, Gerhard Hindricks, Christian Mahnkopf, Darryl Wells, Pierre Jaïs, Prashanthan Sanders, Johannes Brachmann, Jeroen J Bax, Leonie Morrison- de Boer, Thomas Deneke, Hugh Calkins, Christian Sohns, Nassir Marrouche","doi":"10.1016/j.hrthm.2024.08.062","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>We evaluated the impact of lesion delivery on ablation-induced scarring and AF recurrence.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2024.08.062","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
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.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.