Effect of fibrosis regionality on atrial fibrillation recurrence: insights from DECAAF II.

The amount of fibrosis in the left atrium (LA) predicts atrial fibrillation (AF) recurrence after catheter ablation (CA). We aim to identify whether regional variations in LA fibrosis affect AF recurrence. This post hoc analysis of the DECAAF II trial includes 734 patients with persistent AF undergoing first-time CA who underwent late gadolinium enhancement magnetic resonance imaging (LGE-MRI) within 1 month prior to ablation and were randomized to MRI-guided fibrosis ablation in addition to standard pulmonary vein isolation (PVI) or standard PVI only. The LA wall was divided into seven regions: anterior, posterior, septal, lateral, right pulmonary vein (PV) antrum, left PV antrum, and left atrial appendage (LAA) ostium. Regional fibrosis percentage was defined as a region's fibrosis prior to ablation divided by total LA fibrosis. Regional surface area percentage was defined as an area's surface area divided by the total LA wall surface area before ablation. Patients were followed up for a year with single-lead electrocardiogram (ECG) devices. The left PV had the highest regional fibrosis percentage (29.30 ± 14.04%), followed by the lateral wall (23.23 ± 13.56%), and the posterior wall (19.80 ± 10.85%). The regional fibrosis percentage of the LAA was a significant predictor of AF recurrence post-ablation (odds ratio = 1.017, P = 0.021), and this finding was only preserved in patients receiving MRI-guided fibrosis ablation. Regional surface area percentages did not significantly affect the primary outcome. We have confirmed that atrial cardiomyopathy and remodelling are not a homogenous process, with variations in different regions of the LA. Atrial fibrosis does not uniformly affect the LA, and the left PV antral region has more fibrosis than the rest of the wall. Furthermore, we identified regional fibrosis of the LAA as a significant predictor of AF recurrence post-ablation in patients receiving MRI-guided fibrosis ablation in addition to standard PVI.

Assaf A ，Mekhael M ，Noujaim C ，Chouman N ，Younes H ，Feng H ，ElHajjar A ，Shan B ，Kistler P ，Kreidieh O ，Marrouche N ，Donnellan E ... -  《-》

Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial.

Marrouche NF ，Wazni O ，McGann C ，Greene T ，Dean JM ，Dagher L ，Kholmovski E ，Mansour M ，Marchlinski F ，Wilber D ，Hindricks G ，Mahnkopf C ，Wells D ，Jais P ，Sanders P ，Brachmann J ，Bax JJ ，Morrison-de Boer L ，Deneke T ，Calkins H ，Sohns C ，Akoum N ，DECAAF II Investigators ... -  《-》

Early Remodeling of the Left Atrium Following Catheter Ablation of Atrial Fibrillation: Insights From DECAAFII.

Assaf AY ，Noujaim C ，Mekhael M ，Younes H ，Chouman N ，Dhore-Patil A ，Donnellan E ，Feng H ，Shan B ，Kholmovski EG ，Marrouche NF ，Kreidieh O ... -  《-》

Efficacy of LGE-MRI-guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design.

Success rates of catheter ablation in persistent atrial fibrillation (AF) remain suboptimal. A better and more targeted ablation strategy is urgently needed to optimize outcomes of AF treatment. We sought to assess the safety and efficacy of targeting atrial fibrosis during ablation of persistent AF patients in improving procedural outcomes. The DECAAF II trial (ClinicalTrials. gov identifier number NCT02529319) is a prospective, randomized, multicenter trial of patients with persistent AF. Patients with persistent AF undergoing a first-time ablation procedure were randomized in a 1:1 fashion to receive conventional pulmonary vein isolation (PVI) ablation (Group 1) or PVI + fibrosis-guided ablation (Group 2). Left atrial fibrosis and ablation induced scarring were defined by late gadolinium enhancement magnetic resonance imaging at baseline and at 3-12 months postablation, respectively. The primary endpoint is the recurrence of atrial arrhythmia postablation, including atrial fibrillation, atrial flutter, or atrial tachycardia after the 90-day postablation blanking period. Patients were followed for a period of 12-18 months with a smartphone ECG Device (ECG Check Device, Cardiac Designs Inc.). With an anticipated enrollment of 900 patients, this study has an 80% power to detect a 26% reduction in the hazard ratio of the primary endpoint. The DECAAF II trial is the first prospective, randomized, multicenter trial of patients with persistent AF using imaging defined atrial fibrosis as a treatment target. The trial will help define an optimal approach to catheter ablation of persistent AF, further our understanding of influencers of ablation lesion formation, and refine selection criteria for ablation based on atrial myopathy burden.

Marrouche NF ，Greene T ，Dean JM ，Kholmovski EG ，Boer LM ，Mansour M ，Calkins H ，Marchlinski F ，Wilber D ，Hindricks G ，Mahnkopf C ，Jais P ，Sanders P ，Brachmann J ，Bax J ，Dagher L ，Wazni O ，Akoum N ，DECAAF II Investigators ... -  《-》

Preferential regional distribution of atrial fibrosis in posterior wall around left inferior pulmonary vein as identified by late gadolinium enhancement cardiac magnetic resonance in patients with atrial fibrillation.

Benito EM ，Cabanelas N ，Nuñez-Garcia M ，Alarcón F ，Figueras I Ventura RM ，Soto-Iglesias D ，Guasch E ，Prat-Gonzalez S ，Perea RJ ，Borràs R ，Butakoff C ，Camara O ，Bisbal F ，Arbelo E ，Tolosana JM ，Brugada J ，Berruezo A ，Mont L ... -  《-》