Arrhythmias & electrophysiologyCohort study
Differences in atrial substrate localization using late gadolinium enhancement-magnetic resonance imaging, electrogram voltage, and conduction velocity: a cohort study using a consistent anatomical reference frame in patients with persistent atrial fibrillation
- Prospective cohort study
Authors' conclusion
Discordances in detected pathological substrate exist between LVS, CV, and LGE-MRI in the LA, irrespective of the LGE detection method. The new EOIIT method improves concordance of LGE-MRI-based ACM diagnosis with LVS in ablation-naive AF patients but discrepancy remains particularly on the posterior wall.
Study context
- Population
- Ablation-naive patients with persistent atrial fibrillation (AF) undergoing LGE-MRI and high-definition electro-anatomical mapping in sinus rhythm
- Participants
- 36 patients
- Exposure
- LGE-MRI vs electro-anatomical low-voltage substrate (LVS) and slow conduction mapping
Main finding
As reported in the abstract
- Extent and distribution varied significantly across modalities; most discrepancies on posterior left atrium (LA)
- P < 0.001
Observational data: associations, not effects.
Further findings
Concordance of LGE-MRI-based with LVS-based ACM diagnosis (ACM = LVS ≥5% of LA surface at <0.5 mV) · EOIIT applied at the anterior LA
sensitivity
specificity
AUC EOIIT 0.89 · UTAH 0.81 · IIR >1.20 0.67
Optimized image intensity threshold vs mean blood pool intensity
- Linear correlation, R2
- 0.89
- P < 0.001
Original publication
Summarised from the published abstract; every number is checked against it