Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Evaluation of Left Atrial Appendage Isolation Using Cardiac MRI after Catheter Ablation of Atrial Fibrillation: Paradox of Appendage Reservoir

  • Hyungjoon Cho (Department of Radiology, Korea University Anam Hospital) ;
  • Yongwon Cho (Department of Radiology, Korea University Anam Hospital) ;
  • Jaemin Shim (Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Jong-il Choi (Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Young-Hoon Kim (Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Yu-Whan Oh (Department of Radiology, Korea University Anam Hospital) ;
  • Sung Ho Hwang (Department of Radiology, Korea University Anam Hospital)
  • Received : 2020.05.15
  • Accepted : 2020.08.08
  • Published : 2021.04.01
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Abstract

Objective: To assess the effect of left atrial appendage (LAA) isolation on LAA emptying and left atrial (LA) function using cardiac MRI in patients who underwent successful catheter ablation of atrial fibrillation (AF). Materials and Methods: This retrospective study included 84 patients (mean age, 59 ± 10 years; 67 males) who underwent cardiac MRI after successful catheter ablation of AF. According to the electrical activity of LAA after catheter ablation, patients showed either LAA isolation or LAA normal activity. The LAA emptying phase (LAA-EP, in the systolic phase [SP] or diastolic phase), LAA emptying flux (LAA-EF, mL/s), and LA ejection fraction (LAEF, %) were evaluated by cardiac MRI. Results: Of the 84 patients, 61 (73%) and 23 (27%) patients showed LAA normal activity and LAA isolation, respectively. Incidence of LAA emptying in SP was significantly higher in LAA isolation (91% vs. 0%, p < 0.001) than in LAA normal activation. LAA-EF was significantly lower in LAA isolation (40.1 ± 16.2 mL/s vs. 80.2 ± 25.1 mL/s, p < 0.001) than in LAA normal activity. Furthermore, LAEF was significantly lower in LAA isolation (23.7% ± 11.2% vs. 31.1% ± 16.6%, p = 0.04) than in LAA normal activity. Multivariate analysis demonstrated that the LAA-EP was independent from LAEF (p = 0.01). Conclusion: LAA emptying in SP may be a critical characteristic of LAA isolation, and it may adversely affect the LAEF after catheter ablation of AF.

Keywords

Acknowledgement

This research was technically supported by the Korea University Anam Imaging Data (AID) Bank. This research was supported by a grant from Korea University Anam Hospital, Seoul, Republic of Korea (Grant No. O1700361).

References

  1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016;50:e1-e88 
  2. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017;14:e275-e444 
  3. Reddy VY, Sievert H, Halperin J, Doshi SK, Buchbinder M, Neuzil P, et al. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 2014;312:1988-1998 
  4. Naksuk N, Padmanabhan D, Yogeswaran V, Asirvatham SJ. Left atrial appendage: embryology, anatomy, physiology, arrhythmia and therapeutic intervention. JACC Clin Electrophysiol 2016;2:403-412 
  5. Romero J, Cao JJ, Garcia MJ, Taub CC. Cardiac imaging for assessment of left atrial appendage stasis and thrombosis. Nat Rev Cardiol 2014;11:470-480 
  6. Hwang SH, Roh SY, Shim J, Choi JI, Kim YH, Oh YW. Atrial fibrillation: relationship between left atrial pressure and left atrial appendage emptying determined with velocity-encoded cardiac MR imaging. Radiology 2017;284:381-389 
  7. Ohara K, Hirai T, Fukuda N, Sakurai K, Nakagawa K, Nozawa T, et al. Relation of left atrial blood stasis to clinical risk factors in atrial fibrillation. Int J Cardiol 2009;132:210-215 
  8. Di Biase L, Burkhardt JD, Mohanty P, Sanchez J, Mohanty S, Horton R, et al. Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation 2010;122:109-118 
  9. Rillig A, Tilz RR, Lin T, Fink T, Heeger CH, Arya A, et al. Unexpectedly high incidence of stroke and left atrial appendage thrombus formation after electrical isolation of the left atrial appendage for the treatment of atrial tachyarrhythmias. Circ Arrhythm Electrophysiol 2016;9:e003461 
  10. Chavhan GB, Babyn PS, Jankharia BG, Cheng HL, Shroff MM. Steady-state MR imaging sequences: physics, classification, and clinical applications. RadioGraphics 2008;28:1147-1160 
  11. Caudron J, Fares J, Bauer F, Dacher JN. Evaluation of left ventricular diastolic function with cardiac MR imaging. Radiographics 2011;31:239-259 
  12. Muellerleile K, Sultan A, Groth M, Steven D, Hoffmann B, Adam G, et al. Velocity encoded cardiovascular magnetic resonance to assess left atrial appendage emptying. J Cardiovasc Magn Reson 2012;14:39 
  13. Lee HG, Shim J, Choi JI, Kim YH, Oh YW, Hwang SH. Use of cardiac computed tomography and magnetic resonance imaging in case management of atrial fibrillation with catheter ablation. Korean J Radiol 2019;20:695-708 
  14. Lee JW, Hur JH, Yang DH, Lee BY, Im DJ, Hong SJ, et al. Guidelines for cardiovascular magnetic resonance imaging from the Korean society of cardiovascular imaging-part 2: interpretation of cine, flow, and angiography data. Korean J Radiol 2019;20:1477-1490 
  15. Hwang SH, Oh YW, Kim MN, Park SM, Shim WJ, Shim J, et al. Relationship between left atrial appendage emptying and left atrial function using cardiac magnetic resonance in patients with atrial fibrillation: comparison with transesophageal echocardiography. Int J Cardiovasc Imaging 2016;32:163-171 
  16. Lee DK, Shim J, Choi JI, Kim YH, Oh YW, Hwang SH. Left atrial fibrosis assessed with cardiac MRI in patients with paroxysmal and those with persistent atrial fibrillation. Radiology 2019;292:575-582 
  17. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psycho Bull 1979;86:420-428 
  18. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22:276-282 
  19. Wylie JV Jr, Peters DC, Essebag V, Manning WJ, Josephson ME, Hauser TH. Left atrial function and scar after catheter ablation of atrial fibrillation. Heart Rhythm 2008;5:656-662 
  20. Kim JS, Im SI, Shin SY, Kang JH, Na JO, Choi CU, et al. Changes in left atrial transport function in patients who maintained sinus rhythm after successful radiofrequency catheter ablation for atrial fibrillation: a 1-year follow-up multislice computed tomography study. J Cardiovasc Electrophysiol 2017;28:167-176 
  21. Kim YG, Shim J, Oh SK, Lee KN, Choi JI, Kim YH. Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of postisolation flow velocity. Heart Rhythm 2018;15:1746-1753