Sim, I., Lemus, J. A. S., O'Shea, C., Razeghi, O., Whitaker, J., Mukherjee, R., O'Hare, D., Fitzpatrick, N., Harrison, J., Gharaviri, A., O'Neill, L., Kotadia, I., Roney, C. H., Grubb, N., Newby, D. E., Dweck, M. R., Masci, P.-G., Wright, M., Chiribiri, A., ... Williams, S. E. (2025). Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging. Journal of Cardiovascular Electrophysiology, 36(2), 467-479. https://doi.org/10.1111/jce.16462

@article{47f498f113be44708245536622b980f9,
title = "Quantification of atrial cardiomyopathy disease severity by electroanatomic voltage mapping and cardiac magnetic resonance imaging",
abstract = "INTRODUCTION: Atrial late gadolinium enhancement (Atrial-LGE) and electroanatomic voltage mapping (Atrial-EAVM) quantify the anatomical and functional extent of atrial cardiomyopathy. We aimed to explore the relationships between, and outcomes from, these modalities in patients with atrial fibrillation undergoing ablation.METHODS: Patients undergoing first-time ablation had disease severities quantified using both Atrial-LGE and Atrial-EAVM. Correlations between modalities and their relationships with clinical features and arrhythmia recurrence were assessed.RESULTS: In 123 atrial fibrillation patients (60 ± 10 years), Atrial-EAVM was moderately correlated with Atrial-LGE (r = .34, p < .001), with a mean fibrosis burden of 47.2% ± 14.91%. Agreement was strongest in the highest tertile of fibrosis burden (mean of differences 16.8% (95% CI = -24.4% to 57.9%, p = .433). Fibrosis burden was greater for Atrial-LGE than Atrial-EAVM (50.7% ± 10.7% vs. 13.7% ± 7.13%, p < .005) for patients in the lowest tertile who were younger, had smaller atria and a greater frequency of paroxysmal atrial fibrillation. Both Atrial EAVM and Atrial LGE were associated with recurrence of arrhythmia following ablation (Atrial-LGE HR = 1.02 (95% CI = 1.01-1.04), p = .047; Atrial-EAVM HR = 1.02 (95% CI = 1.005-1.03), p = .007). A low fibrosis burden (<15%) by Atrial-EAVM identified patients with very low arrhythmia recurrence. In contrast, a much higher fibrosis burden (>66%) by Atrial-LGE identified patients failing to respond to ablation.CONCLUSIONS: We demonstrate for the first time that the level of agreement between Atrial-EAVM and Atrial-LGE is dependent on the level of atrial cardiomyopathy disease severity. The functional consequences of atrial cardiomyopathy are most evident in patients with the highest anatomical extent of disease.",
keywords = "Humans, Male, Female, Middle Aged, Atrial Fibrillation/physiopathology, Cardiomyopathies/diagnostic imaging, Aged, Fibrosis, Predictive Value of Tests, Catheter Ablation, Action Potentials, Severity of Illness Index, Heart Atria/physiopathology, Recurrence, Electrophysiologic Techniques, Cardiac, Contrast Media/administration & dosage, Magnetic Resonance Imaging, Treatment Outcome, Heart Rate",
author = "Iain Sim and Lemus, {Jose Alonso Solis} and Christopher O'Shea and Orod Razeghi and John Whitaker and Rahul Mukherjee and Daniel O'Hare and Noel Fitzpatrick and James Harrison and Ali Gharaviri and Louisa O'Neill and Irum Kotadia and Roney, {Caroline H} and Neil Grubb and Newby, {David E} and Dweck, {Marc R} and Pier-Giorgio Masci and Matthew Wright and Amedeo Chiribiri and Steven Niederer and Mark O'Neill and Williams, {Steven E}",
note = "{\textcopyright} 2024 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.",
year = "2025",
month = feb,
doi = "10.1111/jce.16462",
language = "English",
volume = "36",
pages = "467--479",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "2",
}