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The Impact of the Atrial Wall Thickness in Less Late-Gadolinium Enhancement Areas on Atrial Fibrillation Drivers in Persistent Atrial Fibrillation Patients
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  • Toshihiro Nakamura,
  • kunihiko kiuchi,
  • Koji Fukuzawa,
  • Mitsuru Takami,
  • yoshiaki watanabe,
  • Yu Izawa,
  • makoto takemoto,
  • jun sakai,
  • atsusuke yatomi,
  • Yusuke Sonoda,
  • Hiroyuki Takahara,
  • Kazutaka Nakasone,
  • Kyoko Yamamoto,
  • Yuya Suzuki,
  • Kenichi Tani,
  • noriyuki negi,
  • Atsushi Kono,
  • Takashi Ashihara,
  • Ken-ichi Hirata
Toshihiro Nakamura
Kobe University Graduate School of Medicine School of Medicine
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kunihiko kiuchi
Kobe University Graduate School of Medicine
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Koji Fukuzawa
Kobe University Graduate School of Medicine
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Mitsuru Takami
Kobe University Graduate School of Medicine
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yoshiaki watanabe
Kobe University Graduate School of Medicine
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Yu Izawa
Kobe University Graduate School of Medicine
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makoto takemoto
Kobe University Graduate School of Medicine
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jun sakai
Kobe University Graduate School of Medicine
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atsusuke yatomi
Kobe University Graduate School of Medicine
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Yusuke Sonoda
Kobe University Graduate School of Medicine
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Hiroyuki Takahara
Kobe University Graduate School of Medicine
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Kazutaka Nakasone
Kobe University Graduate School of Medicine
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Kyoko Yamamoto
Kobe University Graduate School of Medicine
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Yuya Suzuki
Kobe University Graduate School of Medicine Department of Internal Medicine
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Kenichi Tani
Kobe University Hospital
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noriyuki negi
Kobe University Hospital
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Atsushi Kono
Kobe University Graduate School of Medicine
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Takashi Ashihara
Shiga University of Medical Science
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Ken-ichi Hirata
Kobe University Graduate School of Medicine
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Abstract

Background: Some of atrial fibrillation (AF) drivers are found in lesser late-gadolinium enhancement (LGE) areas, as well as heterogenous ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. Objective: The purpose of this study was to evaluate the impact of the AWT in lesser LGE areas on AF drivers. Methods: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non-passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real-time phase mapping (ExTRa Mapping). Lesser LGE areas were defined as areas with a volume ratio of the enhancement voxel of <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE-MRI. Results: NPAs were found in 20 (18.0%) of 131 lesser LGE areas where the AWT was significantly thicker than that in the passively activated areas (PAs) (2.46±0.26 vs. 2.20±0.25 mm, p<0.001). However, NPAs were found in 61 (21.3%) of 287 LGE areas where the AWT was similar to that of the PAs (2.24±0.24 vs. 2.22±0.25 mm, p=0.58). An ROC curve analysis yielded an optimal cutoff value of 2.24 mm for predicting the presence of an NPA in lesser LGE areas. Conclusion: The location of AF drivers in lesser LGE areas might be more accurately identified by evaluating the AWT.