2D Delayed Enhanced MRI To Predict The Effect Of Surgical Treatment On Patients With Atrial Fibrillation

Objective:To detect the degree of left atrial fibrosis and left anterior posterior diameter in patients with rheumatic heart disease complicated with persistent atrial fibrillation by 2D delayed enhanced MRI(LEG-MRI)before surgery,and to find a reliable index that can effectively predict the recovery rate and recurrence rate of patients with atrial fibrillation after radiofrequency ablation.Methods:A total of 30 patients were enrolled in this study,who received LEG-MRI scan before surgery to evaluate the fibrosis situation.The left atrium was divided into 8 quadrants by axial image.According to the degree and range of delayed enhancement,the degree of left atrial fibrosis was divided into 4 levels by image software.CARTO images of all patients were completed before surgery and compared with MRI images.Results:Classification was based on the scope of preoperative MRI image enhancement,4 cases of stage 0,10 cases of stage Ⅰ,10 cases of stage Ⅱ,6 cases of stage Ⅲ.CARTO 4 cases of stage 0,9 cases of stage Ⅰ,11 cases of stage Ⅱ,6 cases of stage III.The diagnostic accuracy of the LGE-MRI atrial fibrosis was 83.3%(25/30),of which the correlation was good(Kappa=0.77,P<0.01).No recurrence of AF in patients with LGE-MRI grade 0(0%),1 cases of stage Ⅰ with AF recurrence(10%),2 cases of stage Ⅱ with AF recurrence(10%),2 cases of stage Ⅲ with AF recurrence(33%)(P<0.05),Stepwise Cox regression analysis showed that preoperative fibrosis degree was an independent risk factor for early postoperative AF recurrence(P=0.02).Conclusion:The higher the degree of left atrial fibrosis before surgery,the higher the recurrence rate of AF after radiofrequency ablation.LGE-MRI can provide a non-invasive way to assess the degree of left atrial fibrosis and may be used as a clinical preoperative test to predict the recurrence of AF after surgical radiofrequency ablation.