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Updated: Apr 28, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial passive emptying function determined by cardiac magnetic resonance predicts atrial fibrillation
John A Dodson1, Tomas G Neilan1, Ravi V Shah1
1From the Division of Aging, Department of Medicine (J.A.D.), Cardiovascular Division, Department of Medicine (H.F., R.B., G.F.M., R.J., S.A.A., R.Y.K.), and Department of Radiology (M.S.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; and Division of Cardiology, Department of Medicine (T.G.N., R.V.S.) and Cardiac MR PET CT Program, Department of Radiology (T.G.N.), Massachusetts General Hospital/Harvard Medical School, Boston, MA.
Background:
Although pulmonary vein isolation has become a mainstream therapy for selected patients with atrial fibrillation (AF), late recurrent AF is common and its risk factors remain poorly defined. The purpose of our study was to test the hypothesis that reduced left atrial passive emptying function (LAPEF) as determined by cardiac magnetic resonance has a strong association with late recurrent AF after pulmonary vein isolation.
Methods And Results:
Three hundred forty-six patients with AF referred for cardiac magnetic resonance pulmonary vein mapping before pulmonary vein isolation were included. Maximum LA volumes (VOLmax) and volumes before atrial contraction (VOLbac) were measured; LAPEF was calculated as (VOLmax-VOLbac)/VOLmax×100. Kaplan-Meier curves were constructed to determine late recurrent AF stratified by LAPEF quintile. Cox proportional hazards regression was used to adjust for known markers of recurrence. During a median follow-up of 27 months, 124 patients (35.8%) experienced late recurrent AF. Patients with recurrence were more likely to have nonparoxysmal AF (75.8% versus 51.4%; P<0.01), higher mean VOLmax (60.2 versus 52.8 mL/m(2); P<0.01), and lower mean LAPEF (19.1% versus 26.0%; P<0.01). Patients in the lowest LAPEF quintile were at highest risk of developing recurrent AF (2-year recurrence for lowest versus highest: 60.5% versus 17.3%; P<0.01). After adjusting for known predictors of recurrence, patients with low LAPEF remained significantly more likely to recur (hazard ratio for lowest versus highest quintile, 3.92; 95% confidence interval, 2.01-7.65).
Conclusions:
We found a strong association between LAPEF and recurrent AF after pulmonary vein isolation that persisted after multivariable adjustment.
