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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EData from a cohort study of the DECAAF trial demonstrate that late gadolinium enhancement magnetic resonance imaging is a useful technique for identifying left atrial scarring following ablation of atrial fibrillation. Of 3 different ablation techniques, cryoablation produces more scarring than does point-by-point and multipolar RF ablation. Neither overall scar nor complete pulmonary vein encirclement was a significant predictor of arrhythmia recurrence.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Epulmonary vein isolation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDECAAF\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elate gadolinium enhancement MRI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epoint-by-point irrigated radiofrequency ablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eduty-cycled multipolar radiofrequency\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eballoon cryoablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial scarring\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eimaging modalities\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EIn a cohort study that used late gadolinium enhancement magnetic resonance imaging (LGE-MRI) to evaluate left atrial (LA) scarring, investigators showed that balloon cryoablation resulted in more scarring compared with point-by-point and multipolar radiofrequency (RF) ablation. These data from a cohort of the DECAAF study [Marrouche NF et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2014] were presented in a poster by Nazem W. Akoum, MD, University of Washington, Seattle, Washington, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe DECAAF study showed an independent association between atrial tissue fibrosis estimated by delayed enhancement MRI and the likelihood of recurrent arrhythmia among patients with AF undergoing catheter ablation [Marrouche NF et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2014]. Pulmonary vein isolation (PVI) is commonly used for catheter ablation of atrial fibrillation (AF). The current cohort study used LGE-MRI to evaluate LA scarring resulting from the techniques used for PVI in the DECAAF study.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study comprised 111 patients with paroxysmal and persistent AF who underwent PVI without additional ablation. Overall scar and pulmonary vein encirclement were compared across 3 different techniques. Point-by-point irrigated RF ablation was used in 91 patients (82.0%), duty-cycled multipolar RF ablation catheter in 8 patients (7.2%), and balloon cryoablation in 12 patients (10.8%). LGE-MRI was obtained 3 months following ablation.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe baseline characteristics of the study participants were not significantly different. The mean age of the mostly male cohort was about 68 years. The most frequent major comorbidities were hypertension, diabetes, and heart failure. Persistent AF was present in 35% of patients, mean left ventricular ejection fraction was 59%, and the mean LA volume was 99 mL. Approximately 20% of patients had evidence of atrial fibrosis.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EOverall scarring was highest in the cryoablation group (13.4\u2005\u00b1\u20056.2%), followed by the point-by-point irrigated RF (10.5\u2005\u00b1\u20054.3%) and the duty-cycled multipolar RF groups (7.1\u2005\u00b1\u20052.3%; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.01 for the group comparison).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EScarring completely encircling all 4 pulmonary veins occurred in 1 of 12 patients (8.3%) in the cryoablation group, 7 of 91 patients (7.7%) who received point-by-point ablation, and no patients in the multipolar RF group.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EBalloon cryoablation resulted in more LA scarring compared with the other techniques. All techniques were poor in achieving complete pulmonary vein encirclement. In this cohort, neither overall scarring nor complete pulmonary vein encirclement was a significant predictor of arrhythmia recurrence.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThis study suggests that the type of ablation used has an impact on scarring but not necessarily on procedural success. Further, ablation of the pulmonary veins did not predict recurrent arrhythmias, supporting the findings from the DECAAF study, which suggested that rather than targeting the pulmonary veins, procedures that ablate fibrotic tissue might produce better outcomes.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/12\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlj5d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}