Arrhythmogenic propensity of the fibrotic substrate after atrial fibrillation ablation: A longitudinal study using magnetic resonance imaging-based atrial models

摘要: AIMS Inadequate modification of the atrial fibrotic substrate necessary to sustain re-entrant drivers (RDs) may explain fibrillation (AF) recurrence following failed pulmonary vein isolation (PVI). Personalized computational models derived from late gadolinium enhanced (LGE)-magnetic resonance imaging (MRI) can be used non-invasively determine presence RDs. The objective this study is assess changes arrhythmogenic propensity after PVI. METHODS AND RESULTS Pre- and post-ablation individualized left were constructed 12 AF patients who underwent pre- post-PVI LGE-MRI, in six whom PVI failed. Pre-ablation sustained by RDs was induced 10 models. classified as either preserved or emergent. for procedure exhibited a higher number larger areas defined promoting RD formation when compared with had successful ablation, 2.6 ± 0.9 vs. 1.8 ± 0.2 18.9 ± 1.6% 13.8 ± 1.5%, respectively. In cases eliminated completely sustaining AF. Preserved unaffected ablation documented only experienced recurrent (2/5 models); all these also one more emergent at locations distinct those pre-ablation Emergent occurred regions that same characteristics fibrosis spatial distribution (entropy density) harboured CONCLUSION Recurrent atria attributable both post-ablation, emergence new ablation. levels entropy density underlie pro-RD substrates.