Pre-ablation Dual-Energy CT-derived Extracellular Volume Fraction Predicts Recurrence After Radiofrequency Ablation...

Area of Science:

• Cardiovascular Imaging
• Cardiac Electrophysiology
• Radiology

Background:

• Non-paroxysmal atrial fibrillation (AF) poses challenges for ablation success.
• Identifying predictors of AF recurrence is crucial for patient management.
• Myocardial fibrosis is implicated in AF pathophysiology.

Purpose of the Study:

• To evaluate if pre-ablation left ventricular extracellular volume fraction (ECV) predicts AF recurrence post-radiofrequency ablation in non-paroxysmal AF.
• To assess the utility of ECV derived from delayed-phase dual-energy cardiac CT angiography (CTA).

Main Methods:

• Retrospective analysis of 399 patients with non-paroxysmal AF undergoing radiofrequency ablation.
• Preprocedural cardiac CTA with delayed-phase imaging to quantify left ventricular ECV.
• Cox proportional hazards models and ROC analysis to identify predictors of AF recurrence.

Main Results:

• AF recurrence occurred in 22.8% of patients during follow-up.
• Higher pre-ablation ECV was significantly associated with AF recurrence (p < 0.01).
• ECV was an independent predictor of AF recurrence (HR = 1.84), improving risk stratification models.

Conclusions:

• Myocardial ECV derived from delayed-phase CT is an independent predictor of AF recurrence in non-paroxysmal AF patients.
• DECT-derived ECV serves as a valuable surrogate marker for diffuse myocardial fibrosis, aiding in AF recurrence risk stratification.