Left Atrial Fibrosis Amelioration Following Cardioversion Assessed with LGE-MRI in Patients with Persistent Atrial Fibrillation
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Background
Previous studies have demonstrated that cardioversion of atrial fibrillation may alleviate atrial remodeling. We aimed to investigate whether left atrial (LA) tissue fibrosis assessed by LGE-MRI, may be reversed after conversion of persistent atrial fibrillation (PersAF) to sinus rhythm.
Methods
Patients with PersAF underwent two LGE-MRI scans following cardioversion were prospectively recruited. LA fibrosis was categorized into core zone (IIR > 1.61) and border zone (0.97<IIR≤1.61) based on the image intensity ratio (IIR). Reverse remodeling of LA was defined as at least a 15% reduction in the max LA volume (LAV). The differences in baseline and follow-up LA structure, function and quantified fibrosis were compared. Multivariable analysis was used to assess the associations of border and core zone changes with other LA parameters.
Results
Fifty-three patients were included. The area of the border [22.2 (11.8-37.0) vs. 18.1 (11.8-25.2) cm 2 , p = 0.037] and core zones [0.9±3.0 vs. 0.1±0.6 cm 2 , p = 0.010] decreased from baseline, along with reductions in LAV, increase of LA ejection fraction and strain. After multivariable adjustment, ΔLATEF was correlated with Δborder zone (r 2 =0.155, p = 0.015), baseline left ventricular mass and ΔLATEF was correlated with Δcore zone (r 2 =0.286, p <0.001). The cardiac reverse remodeling is not related with Δborder zone and Δcore zone.
Conclusions
Atrial fibrosis improved concomitantly with LA shrinkage and enhanced LA function after PersAF to sinus rhythm. LA fibrotic reverse is an independent parameter compared with the traditional definition of cardiac reverse remodeling. The clinical implications warrant further investigation.
