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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\n            \u003Cp id=\u0022p-1\u0022\u003EPrevious studies demonstrated that the structural changes to the heart that are associated with atrial fibrillation (AF) can be quantified using DE-MRI [Oakes RS et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2009]. This article presents data from the Delayed-Enhancement Magnetic Resonance Imaging (DE-MRI) Determinant of Successful Radiofrequency Catheter Ablation for Atrial Fibrillation trial [DECAAF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01150214\u0026amp;atom=%2Fspmdc%2F13%2F3%2F14.atom\u0022\u003ENCT01150214\u003C\/a\u003E]. The DECAAF trial tested the hypothesis that DE-MRI can be used to determine the amount of left atrial fibrosis and\/or remodeling, which predicts the patient\u0027s response to AF ablation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMagnetic Resonance Imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiac Imaging Techniques\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMagnetic Resonance Imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiac Imaging Techniques\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ENassir F. Marrouche, MD, University of Utah, Salt Lake City Utah, USA, presented data from the Delayed-Enhancement Magnetic Resonance Imaging (DE-MRI) Determinant of Successful Radiofrequency Catheter Ablation for Atrial Fibrillation trial [DECAAF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01150214\u0026amp;atom=%2Fspmdc%2F13%2F3%2F14.atom\u0022\u003ENCT01150214\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPrevious studies demonstrated that the structural changes to the heart that are associated with atrial fibrillation (AF) can be quantified using DE-MRI [Oakes RS et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2009]. The DECAAF trial tested the hypothesis that DE-MRI can be used to determine the amount of left atrial fibrosis and\/or remodeling, which predicts the patient\u0027s response to AF ablation.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the international, prospective, multicenter, blinded, follow-up DECAAF trial, 330 patients that were undergoing their first AF ablation procedure were enrolled. Data from 261 patients were analyzed, as 57 MRIs were of poor quality and could not be analyzed and 12 patients were lost to follow-up. Patients were excluded from the study if they had a prior left atrial catheter or surgical ablation, were contraindicated for the DE-MRI contrast agent, were morbidly obese, and\/or were too large for the MRI structure.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe follow-up period consisted of electrocardiogram, or Holter or event monitoring at 3, 6, and 12 months, as well as any additional follow-ups after 12 months, following the ablation procedure. The MARREK DE-MRI software sequence was installed at each participating center, and the staff was trained on five patients prior to enrolling for the DECAAF study. The primary endpoint for the DECAAF trial was recurrence of atrial arrhythmias following a 90-day blanking period.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EQuantification of atrial fibrosis by DE-MRI was categorized based on the Utah Classification System of Left Atrial Structural Remodeling, where stage 1 consists of \u0026lt;10% fibrosis\/remodeling, stage 2 \u226510% to \u0026lt;20%, stage 3 \u226520% to \u0026lt;30%, and stage 4 \u226530% fibrosis\/remodeling. The DECAAF trial results indicate that performing DE-MRI on patients prior to atrial ablation is feasible and produces reproducible data around the world. Interestingly, all patients in the trial had posterior wall involvement, which accounted for about 57% of the total fibrotic tissue in the left atrium. The only predictor of atrial fibrosis was history of hypertension.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAtrial fibrosis and\/or structural remodeling, as quantified by DE-MRI, was demonstrated in multivariate analysis to be the only independent predictor of ablation outcome (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/14\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022DE-MRI-Based Atrial Fibrillation Staging Is Associated With Ablation Procedure Outcome\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1802011303\u0022 data-figure-caption=\u0022DE-MRI-Based Atrial Fibrillation Staging Is Associated With Ablation Procedure Outcome\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/14\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/14\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/14\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13163\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EDE-MRI-Based Atrial Fibrillation Staging Is Associated With Ablation Procedure Outcome\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from NF Marrouche, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EDr. Marrouche concluded that, in his opinion, the data from the DECAAF trial indicates that DE-MRI quantification of atrial fibrosis is a very strong predictor of AF ablation outcome and can be reproduced around the world. He added that DECAAF data would promote DE-MRI based individualized management of the AF and help triaging patients to the appropriate treatment option based on the amount of atrial disease. In the future this would not only help procedural success, but also avoid unnecessary ablation procedures.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\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\/13\/3\/14.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_figures.js?nznyvq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznyvq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}