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After we established correspondence via registration, we mapped the scarred areas of the post-ablation scan through the transformation and marked them on the pre-ablation scan as an area that has been scarred. The pre-ablation wall segmentation becomes marked such that each pixel inside the wall is fibrosis, scar, both, or neither. From this, we subtracted out areas of fibrosis that were scarred over and computed the residual fibrosis by counting the number of remaining fibrosis pixels in the wall and reported their percentage of wall volume (Fig. 4). Figure 4 Two examples of residual fibrosis: the first column represents the pre-ablation fibrosis distribution, the second column represents ablation-induced scarring, the third column represents scarring overlaid on areas of fibrosis, and the fourth column represents ... Inter-observer CSF-1R inhibitor variability Three blinded observers were asked to quantify fibrosis and scarring on randomly selected subjects from this study. The correlation coefficients between observers ranged from 0.82 to 0.97 for fibrosis, 0.98 to 0.99 for scarring, and 0.95 to 0.97 for PV encirclement. This indicates significant reproducibility of the quantified parameters, which reflects the expertise in our laboratory in acquisition, segmentation, and processing of LGE-MRI images. Statistical analysis Continuous variables were reported as means and standard deviations. Categorical variables were reported as a percentage of the overall cohort. Comparison of means was done using a student t-test, PFKM while a chi-square test was used for comparison of proportions. Recurrence was defined according to the HRS consensus document on catheter and surgical treatment of AF.12 Recurrence was evaluated using scheduled 7 day ambulatory monitoring performed at 3, 6, and 12 months, in addition to 12-lead ECGs obtained if patients reported symptoms Protein Tyrosine Kinase inhibitor suggestive of arrhythmia. A Cox proportional hazards model was used to evaluate arrhythmia recurrence. Since baseline and post-ablation residual fibrosis are naturally correlated, separate regression models were built, each including one of these two variables. Up to six variables were included in each of the multivariate models (60 recurrences). A log-rank test was used to compare recurrence between the two groups of residual fibrosis. P values of