The International Journal of Cardiovascular Imaging

, Volume 29, Issue 8, pp 1807–1817 | Cite as

Effect of atrial fibrillation ablation on myocardial function: insights from cardiac magnetic resonance feature tracking analysis

  • Felix Ceelen
  • Ross J. Hunter
  • Redha Boubertakh
  • Wieland H. Sommer
  • Marco Armbruster
  • Richard J. Schilling
  • Steffen E. PetersenEmail author
Original paper


Restoration of sinus rhythm may result in an improvement of left heart function in patients with atrial fibrillation (AF). Cardiovascular magnetic resonance (CMR) feature tracking (FT) technique may help detect subtle wall-motion abnormalities. Consequently this study aimed to analyse existence and reversibility of subclinical cardiac dysfunction following atrial fibrillation ablation. 28 consecutive patients (mean age 61 years) with paroxysmal AF underwent pulmonary vein isolation. CMR imaging was done 3 (±3) days before and 3.4 (±1.1) months after ablation. Left heart function was determined by performing FT analysis. Statistical analysis included paired student’s t test, random effects metaanalysis to assess the cohort’s health status and Bland–Altman analysis. 17 patients (61 %) were free from AF at follow-up. Bland–Altman analysis showed good coefficients of variation. Of all 195 parameters, 27 changed (14 %):9 improved significantly (5 %), 12 worsened significantly (6 %), whereas 6 parameters worsened not significantly (3 %). 18 of 120 systolic parameters changed (15 %), 14 worsened (12 %), 4 improved (3 %). In 9 of 75 diastolic parameters, values changed (12 %): 5 improved (7 %) and 4 worsened (5 %). Meta-analysis revealed that our collective’s FT values at baseline didn’t differ significantly from healthy volunteers’ values [Q values of 0.01 (p value 0.921) and 1.499 (p value 0.221)]. AF patients undergoing ablation appear to have near normal cardiac wall motion, which does not improve following successful ablation. Feature tracking analysis is a reliable tool to determine treatment effects but is more likely to show positive findings if the population is unhealthy.


Feature tracking Atrial fibrillation Ablation Cardiovascular magnetic resonance Wall motion 



The authors declare that they have no competing interests. This work forms part of the research themes contributing to the translational research portfolio of Barts Cardiovascular Biomedical Research Unit which is supported and funded by the National Institute for Health Research.


  1. 1.
    Arbelo E, Brugada J, Hindricks G, Maggioni A, Tavazzi L, Vardas P, Anselme F, Inama G, Jais P, Kalarus Z, Kautzner J, Lewalter T, Mairesse G, Perez-Villacastin J, Riahi S, Taborsky M, Theodorakis G, Trines S (2012) ESC-EUR observational research programme: the atrial fibrillation ablation pilot study, conducted by the European heart rhythm association. Europace 14(8):1094–1103. doi: 10.1093/europace/eus153 CrossRefPubMedGoogle Scholar
  2. 2.
    Tops LF, Bax JJ, Zeppenfeld K, Jongbloed MR, van der Wall EE, Schalij MJ (2006) Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size. Am J Cardiol 97(8):1220–1222. doi: 10.1016/j.amjcard.2005.11.043 CrossRefPubMedGoogle Scholar
  3. 3.
    Reant P, Lafitte S, Jais P, Serri K, Weerasooriya R, Hocini M, Pillois X, Clementy J, Haissaguerre M, Roudaut R (2005) Reverse remodelling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation. Circulation 112(19):2896–2903. doi: 10.1161/CIRCULATIONAHA.104.523928 PubMedGoogle Scholar
  4. 4.
    Morton G, Schuster A, Jogiya R, Kutty S, Beerbaum P, Nagel E (2012) Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson 14:43. doi: 10.1186/1532-429X-14-43 CrossRefPubMedGoogle Scholar
  5. 5.
    Morton G, Jogiya R, Plein S, Schuster A, Chiribiri A, Nagel E (2012) Quantitative cardiovascular magnetic resonance perfusion imaging: inter-study reproducibility. Eur Heart J Cardiovasc Imaging 13(11):954–960. doi: 10.1093/ehjci/jes103 CrossRefPubMedGoogle Scholar
  6. 6.
    Kempny A, Fernandez-Jimenez R, Orwat S, Schuler P, Bunck AC, Maintz D, Baumgartner H, Diller GP (2012) Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of Fallot and healthy controls. J Cardiovasc Magn Reson 14:32. doi: 10.1186/1532-429X-14-32 CrossRefPubMedGoogle Scholar
  7. 7.
    Augustine D, Lewandowski AJ, Lazdam M, Rai A, Francis J, Myerson S, Noble A, Becher H, Neubauer S, Petersen SE, Leeson P (2013) Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender. J Cardiovasc Magn Reson 15(1):8. doi: 10.1186/1532-429X-15-8 CrossRefPubMedGoogle Scholar
  8. 8.
    Hsu LF, Jais P, Sanders P, Garrigue S, Hocini M, Sacher F, Takahashi Y, Rotter M, Pasquie JL, Scavee C, Bordachar P, Clementy J, Haissaguerre M (2004) Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 351(23):2373–2383. doi: 10.1056/NEJMoa041018 CrossRefPubMedGoogle Scholar
  9. 9.
    Gentlesk PJ, Sauer WH, Gerstenfeld EP, Lin D, Dixit S, Zado E, Callans D, Marchlinski FE (2007) Reversal of left ventricular dysfunction following ablation of atrial fibrillation. J Cardiovasc Electrophysiol 18(1):9–14. doi: 10.1111/j.1540-8167.2006.00653.x CrossRefPubMedGoogle Scholar
  10. 10.
    Chen MS, Marrouche NF, Khaykin Y, Gillinov AM, Wazni O, Martin DO, Rossillo A, Verma A, Cummings J, Erciyes D, Saad E, Bhargava M, Bash D, Schweikert R, Burkhardt D, Williams-Andrews M, Perez-Lugones A, Abdul-Karim A, Saliba W, Natale A (2004) Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol 43(6):1004–1009. doi: 10.1016/j.jacc.2003.09.056 CrossRefPubMedGoogle Scholar
  11. 11.
    Hunter RJ, Jones DA, Boubertakh R, Malcolme-Lawes LC, Kanagaratnam P, Juli CF, Davies DW, Peters NS, Baker V, Earley MJ, Sporton S, Davies LC, Westwood M, Petersen SE, Schilling RJ (2012) Diagnostic accuracy of cardiac magnetic resonance imaging in the detection and characterization of left atrial catheter ablation lesions: a multicenter experience. J Cardiovasc Electrophysiol. doi: 10.1111/jce.12063 Google Scholar
  12. 12.
    Hunter RJ, Berriman TJ, Diab I, Baker V, Finlay M, Richmond L, Duncan E, Kamdar R, Thomas G, Abrams D, Dhinoja M, Sporton S, Earley MJ, Schilling RJ (2010) Long-term efficacy of catheter ablation for atrial fibrillation: impact of additional targeting of fractionated electrograms. Heart 96(17):1372–1378. doi: 10.1136/hrt.2009.188128 CrossRefPubMedGoogle Scholar
  13. 13.
    Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ Jr, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D (2012) 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 14(4):528–606. doi: 10.1093/europace/eus027 CrossRefPubMedGoogle Scholar
  14. 14.
    Papavassiliu T, Kuhl HP, Schroder M, Suselbeck T, Bondarenko O, Bohm CK, Beek A, Hofman MM, van Rossum AC (2005) Effect of endocardial trabeculae on left ventricular measurements and measurement reproducibility at cardiovascular MR imaging. Radiology 236(1):57–64. doi: 10.1148/radiol.2353040601 CrossRefPubMedGoogle Scholar
  15. 15.
    Childs H, Ma L, Ma M, Clarke J, Cocker M, Green J, Strohm O, Friedrich MG (2011) Comparison of long and short axis quantification of left ventricular volume parameters by cardiovascular magnetic resonance, with ex vivo validation. J Cardiovasc Magn Reson 13:40. doi: 10.1186/1532-429X-13-40 CrossRefPubMedGoogle Scholar
  16. 16.
    Hof IE, Velthuis BK, Van Driel VJ, Wittkampf FH, Hauer RN, Loh P (2010) Left atrial volume and function assessment by magnetic resonance imaging. J Cardiovasc Electrophysiol 21(11):1247–1250. doi: 10.1111/j.1540-8167.2010.01805.x CrossRefPubMedGoogle Scholar
  17. 17.
    Harrild DM, Han Y, Geva T, Zhou J, Marcus E, Powell AJ (2012) Comparison of cardiac MRI tissue tracking and myocardial tagging for assessment of regional ventricular strain. Int J Cardiovasc Imaging 28(8):2009–2018. doi: 10.1007/s10554-012-0035-3 CrossRefPubMedGoogle Scholar
  18. 18.
    Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU (2003) Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging 17(3):323–329. doi: 10.1002/jmri.10262 CrossRefPubMedGoogle Scholar
  19. 19.
    Maceira AM, Prasad SK, Khan M, Pennell DJ (2006) Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 8(3):417–426CrossRefPubMedGoogle Scholar
  20. 20.
    Hudsmith LE, Petersen SE, Francis JM, Robson MD, Neubauer S (2005) Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J Cardiovasc Magn Reson 7(5):775–782CrossRefPubMedGoogle Scholar
  21. 21.
    Kadiyala MT, R.; Bertman, K.; Pollack, S.; Reichek, N. (2011) Feature Tracking: a novel method to analyze myocardial strain: Results from the CMR strain study in healthy volunteers. Paper presented at the SCMR/Euro CMR Joint Scientific Sessions, Nice, France, 2 February 2011Google Scholar
  22. 22.
    Schuster A, Kutty S, Padiyath A, Parish V, Gribben P, Danford DA, Makowski MR, Bigalke B, Beerbaum P, Nagel E (2011) Cardiovascular magnetic resonance myocardial feature tracking detects quantitative wall motion during dobutamine stress. J Cardiovasc Magn Reson 13:58. doi: 10.1186/1532-429X-13-58 CrossRefPubMedGoogle Scholar
  23. 23.
    Schuster A, Morton G, Hussain ST, Jogiya R, Kutty S, Asrress KN, Makowski MR, Bigalke B, Perera D, Beerbaum P, Nagel E (2013) The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol 82(2):296–301. doi: 10.1016/j.ejrad.2012.11.012 CrossRefPubMedGoogle Scholar
  24. 24.
    Kannel WB, Abbott RD, Savage DD, McNamara PM (1982) Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 306(17):1018–1022. doi: 10.1056/NEJM198204293061703 CrossRefPubMedGoogle Scholar
  25. 25.
    Hunter RJ, Liu Y, Lu Y, Wang W, Schilling RJ (2012) Left atrial wall stress distribution and its relationship to electrophysiologic remodelling in persistent atrial fibrillation. Circ Arrhythm Electrophysiol 5(2):351–360. doi: 10.1161/CIRCEP.111.965541 CrossRefPubMedGoogle Scholar
  26. 26.
    Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L (2009) A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail 11(7):676–683. doi: 10.1093/eurjhf/hfp085 CrossRefPubMedGoogle Scholar
  27. 27.
    Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham heart study. Circulation 107(23):2920–2925. doi: 10.1161/01.CIR.0000072767.89944.6E CrossRefPubMedGoogle Scholar
  28. 28.
    Mirza M, Caracciolo G, Khan U, Mori N, Saha SK, Srivathsan K, Altemose G, Scott L, Sengupta P, Jahangir A (2011) Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study. J Interv Card Electrophysiol 31(3):197–206. doi: 10.1007/s10840-011-9560-6 CrossRefPubMedGoogle Scholar
  29. 29.
    Hammerstingl C, Schwekendiek M, Momcilovic D, Schueler R, Sinning JM, Schrickel JW, Mittmann-Braun E, Nickenig G, Lickfett L (2012) Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures. J Cardiovasc Electrophysiol 23(3):247–255. doi: 10.1111/j.1540-8167.2011.02177.x CrossRefPubMedGoogle Scholar
  30. 30.
    Reant P, Lafitte S, Bougteb H, Sacher F, Mignot A, Douard H, Blanc P, Hocini M, Clementy J, Haissaguerre M, Roudaut R, Jais P (2009) Effect of catheter ablation for isolated paroxysmal atrial fibrillation on longitudinal and circumferential left ventricular systolic function. Am J Cardiol 103(2):232–237. doi: 10.1016/j.amjcard.2008.08.070 CrossRefPubMedGoogle Scholar
  31. 31.
    Tops LF, Delgado V, Bertini M, Marsan NA, Den Uijl DW, Trines SA, Zeppenfeld K, Holman E, Schalij MJ, Bax JJ (2011) Left atrial strain predicts reverse remodelling after catheter ablation for atrial fibrillation. J Am Coll Cardiol 57(3):324–331. doi: 10.1016/j.jacc.2010.05.063 CrossRefPubMedGoogle Scholar
  32. 32.
    Nagel E, Schneider U, Schalla S, Ibrahim T, Schnackenburg B, Bornstedt A, Klein C, Lehmkuhl HB, Fleck E (2000) Magnetic resonance real-time imaging for the evaluation of left ventricular function. J Cardiovasc Magn Reson 2(1):7–14CrossRefPubMedGoogle Scholar
  33. 33.
    Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH (2010) Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European society of cardiology (ESC). Eur Heart J 31(19):2369–2429. doi: 10.1093/eurheartj/ehq278 CrossRefPubMedGoogle Scholar
  34. 34.
    Schneider C, Malisius R, Krause K, Lampe F, Bahlmann E, Boczor S, Antz M, Ernst S, Kuck KH (2008) Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J 29(11):1397–1409. doi: 10.1093/eurheartj/ehn168 CrossRefPubMedGoogle Scholar
  35. 35.
    Jahnke C, Fischer J, Gerds-Li JH, Gebker R, Manka R, Fleck E, Paetsch I, Kriatselis C (2011) Serial monitoring of reverse left-atrial remodeling after pulmonary vein isolation in patients with atrial fibrillation: a magnetic resonance imaging study. Int J Cardiol 153(1):42–46. doi: 10.1016/j.ijcard.2010.08.034 CrossRefPubMedGoogle Scholar
  36. 36.
    Morton G, Schuster A, Jogiya R, Kutty S, Beerbaum P, Nagel E (2012) Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson 14:43. doi: 10.1186/1532-429X-14-43 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Felix Ceelen
    • 1
    • 2
  • Ross J. Hunter
    • 1
  • Redha Boubertakh
    • 1
  • Wieland H. Sommer
    • 2
  • Marco Armbruster
    • 2
  • Richard J. Schilling
    • 1
  • Steffen E. Petersen
    • 1
    • 3
    Email author
  1. 1.Advanced Cardiovascular Imaging, Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, The London Chest HospitalQueen Mary University of LondonLondonUK
  2. 2.Department of Clinical RadiologyUniversity of MunichMunichGermany
  3. 3.Barts and The London School of Medicine and DentistryQueen Mary, University of LondonLondonUK

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