What is the role of preablation delayed-enhancement magnetic resonance imaging (DE-MRI) in predicting treatment outcomes for patients with atrial fibrillation (Afib) (AF)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Preablation delayed-enhancement magnetic resonance imaging (DE-MRI) in patients with AF may be an important tool to not only determine the extent of atrial disease but also to predict treatment outcome. [55, 56]  In the international multicenter Delayed Enhancement-MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation (DECAAF) trial, DE-MRI prior to ablation therapy for atrial fibrillation was able to stage atrial fibrosis and predict ablation success. [55, 56]  Moreover, the greater the extent of fibrotic tissue ablated during the procedure, the better the outcome.

The investigators reported that preablation stage of atrial fibrosis and postablation residual fibrosis were independent predictors of successful ablation or recurrent symptoms. [55, 56]  However, ablation of the pulmonary veins, the standard of care in AF ablation candidates, was not a significant predictor of treatment success. [55, 56]

The DECAAF-II study is under way; this trial will compare the outcomes of patients who undergo index AF ablation using conventional methods to those of patients who undergo ablation that targets areas of left atrial fibrosis as identified on DE-MRI.


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