Abstract 992 Cardiac magnetic resonance based left atrial function and 3D scar is closely linked to low voltage zones in patients with atrial fibrillation

Background:

The relation of poor left atrial function in sinus rhythm and CMR-based left atrial scar to low voltage zones (LVZ) in patients undergoing pulmonary vein isolation (PVI) is not well established.

Methods:

Consecutive patients with symptomatic AF (mean age 67y, 9 men, 10 persistent AF, mean LVEF 60±11%) underwent a CMR in stable sinus rhythm before PVI. Patients were excluded, if they have had a electrical cardioversion in the past 4 weeks.

From feature-tracking of CMR-cine images left atrial emptying fraction (LAEF) was calculated. In 12 out of 50 patients with suitable CMR images a severly decreased LAEF<20% was found, defined as atrial stunning. CMR based 3D- post contrast Inversion recovery sequences were used for left atrial scar (core and borderzone) acquisition and was quantified by ADAS-3D segmentation software. During PVI low voltage zones of the left atrium were recorded.

Results:

In all 12 patients with atrial stunning CMR-derived left atrial scar was present and low voltage zones were found in 10 of 12 patients.

The extent of left atrial low voltage (median 52%, 26-72%) was highly significantly correlated to the amount of left atrial scar (median 40%, 28-70%) ( r= 0,6, p<0,01). Based on this findings exta PV ablation was guided using linear lesions.

Conclusion:

In selected patients left atrial myopathy, suspected by invasively detected low voltage zones, is confirmed by the existance of atrial scar on CMR. Additionally left atrial function is severly decreased, if scar and low voltage areas are present.

It seems possible that the presence of atrial low voltage maybe easily predicted by atrial mechanical function, so that AF treatment can be individually adjusted.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Cardiac magnetic resonance based left atrial function and 3D scar is closely linked to low voltage zones in patients with atrial fibrillation
L. Pu¹, M. Wagner², J. Tomala³, Y. Huo², U. Richter⁴, J. Mayer⁴, A. M. Zedda², B. Kirstein⁵, A. Haferkorn², C. Piorkowski⁶, T. Gaspar⁴, S. Ulbrich⁴, für die Studiengruppe: AFMRI
¹Herzzentrum Dresden GmbH an der TU Dresden, Dresden; ²Rhythmologie, Herzzentrum Dresden GmbH an der TU Dresden, Dresden; ³Klinik für Innere Medizin, Kardiologie und Intensivmedizin, Herzzentrum Dresden GmbH an der TU Dresden, Dresden; ⁴Abteilung für Invasive Elektrophysiologie, Herzzentrum Dresden GmbH an der TU Dresden, Dresden; ⁵Med. Klinik II / Kardiologie, Elektrophysiologie, Universitätsklinikum Schleswig-Holstein, Lübeck; ⁶Abbott Medical GmbH, Eschborn;
Background: The relation of poor left atrial function in sinus rhythm and CMR-based left atrial scar to low voltage zones (LVZ) in patients undergoing pulmonary vein isolation (PVI) is not well established. Methods: Consecutive patients with symptomatic AF (mean age 67y, 9 men, 10 persistent AF, mean LVEF 60±11%) underwent a CMR in stable sinus rhythm before PVI. Patients were excluded, if they have had a electrical cardioversion in the past 4 weeks. From feature-tracking of CMR-cine images left atrial emptying fraction (LAEF) was calculated. In 12 out of 50 patients with suitable CMR images a severly decreased LAEF<20% was found, defined as atrial stunning. CMR based 3D- post contrast Inversion recovery sequences were used for left atrial scar (core and borderzone) acquisition and was quantified by ADAS-3D segmentation software. During PVI low voltage zones of the left atrium were recorded. Results: In all 12 patients with atrial stunning CMR-derived left atrial scar was present and low voltage zones were found in 10 of 12 patients. The extent of left atrial low voltage (median 52%, 26-72%) was highly significantly correlated to the amount of left atrial scar (median 40%, 28-70%) ( r= 0,6, p<0,01). Based on this findings exta PV ablation was guided using linear lesions. Conclusion: In selected patients left atrial myopathy, suspected by invasively detected low voltage zones, is confirmed by the existance of atrial scar on CMR. Additionally left atrial function is severly decreased, if scar and low voltage areas are present. It seems possible that the presence of atrial low voltage maybe easily predicted by atrial mechanical function, so that AF treatment can be individually adjusted.
https://dgk.org/kongress_programme/jt2022/aP1218.html