Hyperenhancement of LA Wall by Three-Dimensional High-Resolution Late Gadolinium-Enhanced MRI and Recurrence of AF After Catheter Ablation

<b>Background/Objectives</b>: This study investigated the relationship between LA (LA) enhancement on three-dimensional (3D) late gadolinium enhancement (LGE) MRI and recurrence after catheter ablation in patients with AF (AF). <b>Methods</b>: A total of one hundred patients with AF (mean age: 68 ± 9 years, 50% with paroxysmal AF) were included in this study. Each patient underwent a high-resolution 3D LGE MRI prior to catheter ablation, allowing for detailed imaging of the LA wall. Quantitative analysis of the enhancement was performed using dedicated software designed for volumetric measurements of LA LGE. Recurrence of AF was monitored over a 90-day period following the ablation procedure. The primary outcome was the correlation between the volume of LGE in the LA and the recurrence of AF. <b>Results</b>: Multivariate analysis confirmed that the volume of LA LGE, defined as the volume exceeding 1SD above the mean signal intensity of the LA, was an independent predictor of recurrence [hazard ratio: 1.16 (95%CI: 1.04-1.29, <i>p</i> = 0.0057)]. The area under the curve for recurrence prediction using 3D LGE MRI was 0.74 (95%CI: 0.63-0.86), with an optimal threshold of 11.72 mL, providing a sensitivity of 55% (95%CI: 32-77%) and a specificity of 86% (95%CI: 77-93%). <b>Conclusions</b>: LA enhancement assessed by high-resolution LGE MRI may serve as a valuable imaging marker for predicting the recurrence in patients with AF following catheter ablation.