DECAAF study

I searched the archives and maybe I missed it, but I just read an article about the DECAAF Study using MRIs to measure the extent of atrial fibrosis before an ablation, and the potential use of a cardiac MRI as a predictor of ablation success or afib recurrence. The article was published early this year.

It was a small study across 15 centers worldwide, and a total of 272 patients underwent cardiac MRI. One of the results of the study was that patients with many years of AF do not necessarily have a higher degree of fibrosis. What was not surprising is that the recurrence rate of afib after ablation correlated with a higher percentage of fibrosis.

Jama article

It would seem (from a small study) that this would be a valuable tool to predict good or poor candidates for ablation. Anybody have experience with a cardiac MRI that measures the extent of fibrosis prior to an ablation?

Doreen

Doreen, In the video below Prof Jais talks about the latest thinking with respect to fibrosis and AF ablation. It's the top video on the list.

[www.innovationsincrm.com]

-- Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014 Feb 5
Mohamed ElMaghawry, Soha Romeih
[www.ncbi.nlm.nih.gov]

-- Related, posted to this forum a few weeks ago: [www.afibbers.org]

-- DECAAF: Emphasizing the importance of MRI in AF ablation Jan-Feb 2015 [www.qscience.com]
Mohamed ElMaghawry, Soha Romeih
Department of Cardiology, Aswan Heart Centre, Egypt

Quote:
DECAAF: DESIGN AND OUTCOMES
Delayed-Enhancement MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial
Fibrillation (DECAAF) was a multicenter, prospective, observational cohort study of patients diagnosed
with paroxysmal and persistent AF, and undergoing their first catheter ablation, conducted between
August 2010 and August 2011 at 15 centers in the United States, Europe, and Australia.



Edited 1 time(s). Last edit at 08/17/2015 04:14PM by Moerk.

Thanks, researcher, and thanks, Moerk.

I watched the Dr. Jais video on my lunch break. I need an electrical engineer to translate much of it

I guess my next questions are these:

1) Will insurance cover the mapping/MRI before ablation?
2) Does anyone know if there are any centers that are actively testing this technology?
3) Does Dr. Natale's practice use mapping/MRI before ablation?

If extensive fibrosis is found, it may result in patients opting for meds instead of ablation. I would think the ideal would be to have the results a few weeks before the ablation is scheduled to assist in informed decision making. It would certainly aid in decision making for me.

If the preliminary numbers are confirmed in future studies and it becomes the standard of care in the future, I can see a downside where insurers make a formula determination as to what percentage of fibrosis eliminates insurance coverage for ablation.

I'm going to ask Dr. Schweikert if he uses this technology during my next consult.

Doreen

My EP said that only a few centers specializing in Cardiac MRI's would even know how to read a cardiac MRI, as the average radiologist has never even seen a Cardiac MRI before, and haven't been trained to interpret them.

The Univ of Utah has a center specializing in them. This was discussed recently here:

[www.afibbers.org]

It looks like Cleveland Clinic has cardiac MRIs. I'll be bringing the study with me to my appointment in Akron.

Ok, so obviously I was on vacation in July during the time this thread originally came up (under another name) and I just read Shannon's passionate argument against pre-ablation MRIs.

I still feel they may be valuable for decision-making for those fortunate people who have had relatively good control with medicines and are on the fence about moving onto the next med or doing the ablation (or needing two or three ablations, even with the top tier ablationists).

Doreen

I spoke to Dr Natale about Utah Staging before my ablation and he felt it was fairly useless in identifying fibrosis in many areas of the heart and would be a disservice to base having an ablation on these staging scores until you get in there.
But then again any lesser experienced EP would shy away on performing an ablation on someone with more advanced scarring fearing a less then positive outcome. Natale is still skilled enough to shut down afib even in more advanced cases of fibrosis so relying on Utah Staging would eliminate many candidates who could still have successful ablations..

McHale