Multiparametrische Auswertung kardialer MRT-Aufnahmen vor und nach Pulmonalvenenisolation als Therapie des Vorhofflimmerns
by Lukas Bauer
Date of Examination:2023-10-12
Date of issue:2023-08-18
Advisor:Prof. Dr. Wieland Staab
Referee:Prof. Dr. Wieland Staab
Referee:Prof. Dr. Dr. Andreas Schuster
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EnglishAtrial fibrillation is the most common cardiac arrhythmia worldwide and is associated with high socioeconomic costs. The identification of pulmonary veins as trigger foci provided the basis for the therapeutic option of pulmonary vein isolation, which is recommended as a rhythm control option in current guidelines in an increasing number of patients. Catheter ablation is still associated with relevant recurrence rates. There is disagreement in the scientific literature about reliable prognostic factors for ablation success. Feature tracking opened a new, uncomplicated possibility to quantify and assess left atrial function by wall deformation parameters using cardiac magnetic resonance imaging. The present scientific work addressed the question whether these left atrial wall deformation parameters differ between patients with and without ablation success and investigated their predictive value. At the same time, the patient population was examined for differences in clinical parameters and in the results of classical volumetric analyses. A total of 57 patients with atrial fibrillation and successful pulmonary vein isolation were included in the scientific work. Cardiac magnetic resonance imaging was performed immediately before catheter ablation and three months later. Patients were followed up for a median of ten months. In addition to a survey of clinical parameters, cardiac magnetic resonance imaging was analyzed by left ventricular and left atrial volumetry and left atrial feature tracking. It was investigated whether the parameters collected showed significant differences and predictive value regarding ablation success in patients with and without ablation success. Consistent with current literature, imaging-independent studies showed significant differences in terms of NT-proBNP concentration and EHRA score between patients with and without ablation success, whereas no differences were observed in the remaining patient characteristics. The present work is one of the first studies comparing left atrial wall deformation parameters by feature tracking in patients before and after pulmonary vein isolation. In particular, left atrial strain parameters after catheter ablation not only differed significantly between patients with and without ablation success, but also had predictive value for intervention success. With regard to the prediction of ablation success, the present study provided evidence that left atrial feature tracking can provide more reliable parameters than classical volumetry of the left atrium and ventricle. The predictive value of left atrial feature tracking seemed to be particularly evident in patients with paroxysmal atrial fibrillation. In the future, further scientific work will be needed to confirm this evidence in larger prospective studies with larger patient populations. Feature tracking of the left atrium as part of a comprehensive analysis of cardiac morphology, structure, and function using cardiac magnetic resonance imaging could facilitate as well as optimize therapy selection in patients with AF.
Keywords: Atrial Fibrillation; Feature Tracking