DECAAF Published: MRI Aids in AF Ablation Success

February 05, 2014

SALT LAKE CITY, UT — The Delayed Enhancement-MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation (DECAAF) study, which shows that MRI can be used to detect the degree of atrial fibrosis and predict ablation success, is now published[1].

First reported by heartwire last September at the European Society of Cardiology (ESC) 2013 Congress, DECAAF was published in the February 5, 2014 issue of the Journal of the American Medical Association. As lead author Dr Nasir Marrouche (University of Utah, Salt Lake City) explained at the ESC Congress, atrial tissue fibrosis in the left atrium contributes to the progression of atrial fibrillation; and the more fibrosis there is, the more likely the arrhythmia will persist following ablation.

The findings published in JAMA are in line with the data presented at the ESC Congress. Briefly, atrial fibrosis estimated by delayed-enhancement MRI in 260 atrial-fibrillation patients, including 65% with paroxysmal atrial fibrillation, was a significant predictor of recurrence. Each 1% increase in fibrosis was associated with a 6% increased risk of recurrence.

"The extent of atrial disease was the only predictor of outcomes," Marrouche said about the DECAAF results in September. "When you look at the MRI, you can predict the chance of the patient having a recurrence, independent of the operator, experienced centers, and type of lesions. And as you all know, for the past 15 years we've been targeting the pulmonary veins to isolate and treat atrial fibrillation. This is another major finding, that encircling the veins with lesions as seen on the MRI was not important in terms of treatment success."

At one year, 88% of patients with stage 1 fibrosis were free of atrial fibrillation. For those with stage 2, 3, or 4 fibrosis, respectively, 69%, 55%, and 45% were free of recurrence at one year. At 475 days, 86%, 64%, 51%, and 35% of those with stage 1, 2, 3, and 4 fibrosis were free of atrial fibrillation, respectively.

Marrouche has received honoraria from Biotronik, Siemens, Boston Scientific, and Boehringer Ingelheim; consulting fees from Sanofi and eCardio; research grants from eCardio and estech; and equipment from Siemens. He also has stock options with MRI-Interventions and holds stock in Marreck.


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