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Agbaedeng TA, Emami M, Munawar DA, Rattanakosit T, Khadim KI, Elliott A, Linz D, Mahajan R, Lau DH, Sanders P. P5657Fibrosis detected by late-gadolinium enhancement cardiac MRI is associated with atrial fibrillation and poorer ablation outcome: A meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Fibrosis is a hallmark of atrial fibrillation (AF) substrate. Recent data suggests that fibrosis detected by late-gadolinium enhancement (LGE) cardiac MRI (CMR) can predict AF. However, this relationship is not well described.
Objective
To delineate the association of cardiac fibrosis detected by LGE CMR with AF prevalence, AF recurrence after catheter ablation.
Methods
PubMed, Embase, Web of Science and Ovid MEDLINE were searched through November 2018, using the keywords: LGE AND Fibrosis AND CMR AND AF. Inclusion criteria: 1. LGE CMR of left atrial (LA LGE), ventricular wall (LV LGE) or right ventricular wall (RV LGE); 2. Studies reporting AF or recurrent arrhythmia after ablation; 3. Patient ≥18 years; and 4. ≥50 participants. Included studies were pooled in a random effects meta-analysis and reported as: mean difference (MD); unadjusted risk ratios (RR); adjusted hazard ratios (HR); and 95% confidence intervals (95% CI).
Results
After exclusions, we identified 9 studies (2,307 patients [65.9% males, 34.1% females]) conducted between 2003 and 2015 for LGE and AF. Fibrosis was present in 666 (35.1%) and detected by LV LGE in 7 (78%) and RV LGE in 2 (22%). The presence of AF was higher in patients positive for ventricular LGE than those negative, trending towards significance (RR: 1.51, 95% CI: 0.94–2.45, p=0.09). Pooled LV fibrosis associated with AF progression (RR [NPAF vs. PAF]: 2.2, 95% CI: 1.22–3.94, p=0.009). We identified 8 studies (2,041 patients [65.8% males, 34.2% females]) conducted between 2006 and 2016 reporting LGE and AF recurrence after catheter ablation, with fibrosis detected in 644 (31.6%) by LA LGE in 8 (88.9%, biased towards one centre). After 17.8±14.2 follow-up years, atrial fibrosis was significantly greater in recurrent AF than controls (MD: 4.97%, 95% CI: 1.23–8.7, p<0.01), and predicted 16% increased risk of AF recurrence (RR: 1.16, 95% CI: 1.07–1.26, p<0.05).
Conclusion
Myocardial fibrosis detected by LGE associates with prevalence and progress of AF and is predictive of AF recurrence post ablation. This further supports the proarrhythmic role of fibrosis and selection of patients for ablation therapy based on LGE.
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Affiliation(s)
- T A Agbaedeng
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Emami
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D A Munawar
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - T Rattanakosit
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K I Khadim
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Khokhar KB, Lau D, Elliott A, Mahajan R, Thiyagarajah A, Munawar DA, Stiles M, Linz DA, Agbaedeng TA, Emami M, Kadhim KB, Mishimi R, Harrington J, Sanders P. P1941Association of aortic stiffness and new onset AF- A meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K B Khokhar
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - D Lau
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - A Elliott
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - R Mahajan
- Waikato District Hospital, Cardiology, Waikato, New Zealand
| | - A Thiyagarajah
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - D A Munawar
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - M Stiles
- Waikato District Hospital, Cardiology, Waikato, New Zealand
| | - D A Linz
- Waikato District Hospital, Cardiology, Waikato, New Zealand
| | - T A Agbaedeng
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - M Emami
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - K B Kadhim
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - R Mishimi
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - J Harrington
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - P Sanders
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
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Munawar DA, Mahajan R, Khokhar K, Thiyagarajah A, Kadhim K, Misima R, Gallagher C, Middeldorp ME, Hendriks J, Linz DA, Lau DH, Munawar M, Sanders P. P380Peri-ablation novel oral anticoagulant management: Systematic review and meta-analysis. Europace 2018. [DOI: 10.1093/europace/euy015.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - R Mahajan
- University of Adelaide, Adelaide, Australia
| | - K Khokhar
- University of Adelaide, Adelaide, Australia
| | | | - K Kadhim
- University of Adelaide, Adelaide, Australia
| | - R Misima
- University of Adelaide, Adelaide, Australia
| | | | | | - J Hendriks
- University of Adelaide, Adelaide, Australia
| | - D A Linz
- University of Adelaide, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Adelaide, Australia
| | - M Munawar
- National Cardiovascular Center Harapan Kita, Dept of Cardiology and Vascular Medicine, FKUI, Jakarta, Indonesia
| | - P Sanders
- University of Adelaide, Adelaide, Australia
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Mishima RS, Emami M, Kadhim K, Thiyagarajah A, Khokhar KB, Munawar DA, Linz D, Mahajan R, Lau DH, Sanders P. P929Atrial diverticula as a source of focal atrial tachycardia. Europace 2018. [DOI: 10.1093/europace/euy015.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R S Mishima
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Emami
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K Kadhim
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Thiyagarajah
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K B Khokhar
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D A Munawar
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Elliott A, Verdicchio CV, Gallagher C, Munawar DA, Linz D, Stokes MB, Middeldorp ME, Mahajan R, Lau DH, Sanders P. P1188Exercise Intolerance in AF Patients: A consequence of rhythm status or myocardial impairment? Europace 2018. [DOI: 10.1093/europace/euy015.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C V Verdicchio
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C Gallagher
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D A Munawar
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M B Stokes
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M E Middeldorp
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Thiyagarajah A, Emami M, Khokhar KB, Kadhim K, Mishima R, Munawar DA, Linz D, Mahajan R, Lau DH, Sanders P. P935Epicardial connections can complicate box isolation for AF - a case series. Europace 2018. [DOI: 10.1093/europace/euy015.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Thiyagarajah
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - M Emami
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - K B Khokhar
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - K Kadhim
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - R Mishima
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - D A Munawar
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - D Linz
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - R Mahajan
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - D H Lau
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - P Sanders
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
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Emami M, Mishima RS, Kadhim K, Thiyagarajah A, Munawar DA, Khokhar KB, Wells R, Linz D, Mahajan R, Lau D, Sanders P. P433Case series of radiofrequency ablation for drug resistant inappropriate sinus tachycardia. Europace 2018. [DOI: 10.1093/europace/euy015.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Emami
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R S Mishima
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K Kadhim
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Thiyagarajah
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D A Munawar
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K B Khokhar
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Wells
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Middeldorp ME, Elliott AD, Gupta A, Gallagher C, Hendriks JM, Munawar DA, Khokhar K, Thiyagarajah A, Mahajan R, Lau DH, Sanders P. P388What and how many reactions caused by novel oral anticoagulation use? Europace 2018. [DOI: 10.1093/europace/euy015.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - A Gupta
- University of Adelaide, Adelaide, Australia
| | | | | | | | - K Khokhar
- University of Adelaide, Adelaide, Australia
| | | | - R Mahajan
- University of Adelaide, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Adelaide, Australia
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