Good news for patients with atrial fibrillation (AF): thanks to a novel application of MRI technology, we are now able to stage the progression of their disease. Even more exciting is the fact that our staging models show great promise as a tool for predicting the outcomes for catheter ablation procedures based on patients’ pre-ablation images.

Our research at the University of Utah uses 3D delayed-enhancement magnetic resonance imaging (DE-MRI) to determine the degree of fibrosis in the left atrial myocardial tissue of AF patients before radiofrequency ablation. We developed protocols and pulse sequences to optimize the images.

Patients were classified in one of three categories based on the extent of enhancements — early (<15% enhancement), moderate (15-34% enhancement) or advanced (>35% enhancement). We then assessed the patients at least six months after the procedure, and found that only 14 percent in the early stage had suffered AF recurrence compared to 75 percent recurrence in the advanced stage group.

The results indicate this model could be used to better define candidates for ablation, predict long-term prognoses and, in the future, perhaps assess risks for strokes and heart failure.

Three-dimensional, high-resolution imaging has tremendous potential in AF diagnosis and treatment, and researchers are collaborating worldwide to develop new techniques for improving clinical outcomes. For information on some of these AF research projects, visit the University of Utah’s CARMA (Comprehensive Arrhythmia Research & Management) Center, which is providing worldwide pioneering leadership in advancing clinical treatments and research for cardiac arrhythmias, especially AF.

Nassir F. Marrouche, MD is the Executive Director of the Comprehensive Arrhythmia Research & Management Center, Director of Electrophysiology Laboratories, and Director of the Atrial Fibrillation Program at the University of Utah School of Medicine, Division of Cardiology.