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Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 6/2015

01-06-2015 | Cardiac Magnetic Resonance (E Nagel and V Puntmann, Section Editors)

Advances in CMR of Post-ablation Atrial Injury

Authors: James L. Harrison, John Whitaker, Henry Chubb, Steven E. Williams, Matthew Wright, Reza S. Razavi, Mark D. O’Neill

Published in: Current Cardiovascular Imaging Reports | Issue 6/2015

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Abstract

Technical advancements in cardiac magnetic resonance (CMR) imaging over the past two decades have allowed clinically useful imaging of the thin atrial wall for the first time. During this period, there has been a parallel increase in the use of catheter ablation to treat atrial fibrillation (AF). These developments have led to new indications for and increasing use of CMR in the assessment of pre- and post-ablation atrial structure and function and their potential link to arrhythmia substrate. This review focuses on the role of CMR in the assessment of acute and chronic post-ablation atrial tissue characterisation and its potential use in the treatment of atrial arrhythmias.
Literature
1.
Lardo AC, Mcveigh ER, Jumrussirikul P, Berger RD, Calkins H, Halperin HR. Visualization and temporal/spatial characterization of cardiac radiofrequency ablation lesions using magnetic resonance imaging. Circulation. 2000;102:698–705.CrossRefPubMed
2.
Dickfeld T, Kato R, Zviman M, Lai S, Meininger G, Lardo AC, et al. Characterization of radiofrequency ablation lesions with gadolinium-enhanced cardiovascular magnetic resonance imaging. J Am Coll Cardiol. 2006;47:370–8.CrossRefPubMedCentralPubMed
3.
Dickfeld T, Kato R, Zviman M, Nazarian S, Dong J, Ashikaga H, et al. Characterization of acute and subacute radiofrequency ablation lesions with nonenhanced magnetic resonance imaging. Heart Rhythm. 2007;4:208–14.CrossRefPubMedCentralPubMed
4.
Vergara GR, Vijayakumar S, Kholmovski EG, Blauer JJEE, Guttman MA, Gloschat C, et al. Real-time MRI guided radiofrequency atrial ablation and visualization of lesion formation at 3-tesla. Hear Rhythm. Elsevier Inc.; 2011;8:295–303.
5.
Nordbeck P, Hiller K-H, Fidler F, Warmuth M, Burkard N, Nahrendorf M, et al. Feasibility of contrast-enhanced and nonenhanced MRI for intraprocedural and postprocedural lesion visualization in interventional electrophysiology: animal studies and early delineation of isthmus ablation lesions in patients with typical atrial flutter. Circ Cardiovasc Imaging. 2011;4:282–94.CrossRefPubMed
6.•
Ranjan R, Kholmovski EG, Blauer J, Vijayakumar S, Volland NA, Salama ME, et al. Identification and acute targeting of gaps in atrial ablation lesion sets using a real-time magnetic resonance imaging system. Circ Arrhythm Electrophysiol. 2012;5:1130–5. A study demonstrating the ability of real time magnetic resonance imaging to guide radiofrequency ablation. This study provides compelling experimental evidence justifying the trial of real time CMR in human studies, which are currently underway.CrossRefPubMedCentralPubMed
7.••
Harrison JL, Jensen HK, Peel SA, Chiribiri A, Grøndal AK, Bloch LØ, et al. Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study. Eur Heart J. 2014;35:1486–95. The first correlation of magnetic resonance imaging data with a comprehensive histopathological tissue assessment in a bovine model. This work identified the role of T2 weighted imaging and LGE in the quantitative assessment of acute and chronic atrial scar.CrossRefPubMed
8.
Peters DC, Wylie JV, Hauser TH, Nezafat R, Han Y, Woo JJ, et al. Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement: a pilot study. JACC Cardiovasc Imaging. Elsevier Inc.; 2009;2:308–16.
9.
Peters DC, Wylie JV, Hauser TH, Kissinger KV, Josephson ME, Manning WJ. Detection of pulmonary vein and left atrial scar after catheter ablation with three-dimensional navigator-gated delayed enhancement mr imaging: methods: results: conclusion. 2007;243
10.
Knowles BR, Caulfield D, Cooklin M, Rinaldi CA, Gill J, Bostock J, et al. 3-D visualization of acute RF ablation lesions using MRI for the simultaneous determination of the patterns of necrosis and edema. IEEE Trans Biomed Eng. 2010;57:1467–75.CrossRefPubMed
11.
Arujuna A, Karim R, Caulfield D, Knowles B, Rhode K, Schaeffter T, et al. Acute pulmonary vein isolation is achieved by a combination of reversible and irreversible atrial injury after catheter ablation: evidence from magnetic resonance imaging. Circ Arrhythm Electrophysiol. 2012;5:691–700.CrossRefPubMed
12.
Badger TJ, Daccarett M, Akoum NW, Adjei-Poku YA, Burgon NS, Haslam TS, et al. Evaluation of left atrial lesions after initial and repeat atrial fibrillation ablation: lessons learned from delayed-enhancement MRI in repeat ablation procedures. Circ Arrhythm Electrophysiol. 2010;3:249–59.CrossRefPubMedCentralPubMed
13.
Badger TJ, Oakes RS, Daccarett M, Burgon NS, Akoum N, Fish EN, et al. Temporal left atrial lesion formation after ablation of atrial fibrillation. HRTHM. Heart Rhythm Society; 2009;6:161–68.
14.
McGann CJ, Kholmovski EG, Oakes RS, Blauer JJE, Daccarett M, Segerson N, et al. New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J Am Coll Cardiol. 2008;52:1263–71.CrossRefPubMed
15.•
Bisbal F, Guiu E, Cabanas-Grandío P, Berruezo A, Prat-Gonzalez S, Vidal B, et al. CMR-guided approach to localize and ablate gaps in repeat AF ablation procedure. JACC Cardiovasc Imaging. 2014;7:653–63. This study raises the novel possibility of purely CMR guided ablation of atrial fibrillation. If successfully reproduced, the results suggest the prospect of a purely imaging guided approach to the ablation of atrial fibrillation.CrossRefPubMed
16.
Khurram IM, Beinart R, Zipunnikov V, Dewire J, Yarmohammadi H, Sasaki T, et al. Magnetic resonance image intensity ratio, a normalized measure to enable interpatient comparability of left atrial fibrosis. Heart Rhythm. Elsevier; 2014;11:85–92.
17.
Oakes RS, Badger TJ, Kholmovski EG, Akoum N, Burgon NS, Fish EN, et al. Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation. 2009;119:1758–67.CrossRefPubMedCentralPubMed
18.
Badger TJ, Adjei-Poku YA, Burgon NS, Kalvaitis S, Shaaban A, Sommers DN, et al. Initial experience of assessing esophageal tissue injury and recovery using delayed-enhancement MRI after atrial fibrillation ablation. Circ Arrhythm Electrophysiol. 2009;2:620–5.CrossRefPubMed
19.
Mcgann C, Kholmovski E, Blauer J, Vijayakumar S, Haslam T, Cates J, et al. Dark regions of no-reflow on late gadolinium enhancement magnetic resonance imaging result in scar formation after atrial fibrillation ablation. J Am Coll Cardiol. Elsevier Inc.; 2011;58:177–85.
20.
Spragg DD, Khurram I, Zimmerman SL, Yarmohammadi H, Barcelon B, Needleman M, et al. Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Hear Rhythm. 2012;9:2003–9.CrossRef
21.
Sohns C, Karim R, Harrison J, Arujuna A, Linton N, Sennett R, et al. Quantitative magnetic resonance imaging analysis of the relationship between contact force and left atrial scar formation after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25:138–45.
22.
Badger TJ, Oakes RS, Daccarett M, Burgon NS, Akoum N, Fish EN, et al. Temporal left atrial lesion formation after ablation of atrial fibrillation. Heart Rhythm. Heart Rhythm Society; 2009;6:161–68.
23.
Sohns C, Karim R, Harrison J, Arujuna A, Linton N, Sennett R, et al. Quantitative magnetic resonance imaging analysis of the relationship between contact force and left atrial scar formation after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2013;138–45.
24.
Segerson NM, Daccarett M, Badger TJ, Shabaan A, Akoum NW, Fish EN, et al. Magnetic resonance imaging-confirmed ablative debulking of the left atrial posterior wall and septum for treatment of persistent atrial fibrillation: rationale and initial experience. J Cardiovasc Electrophysiol. 2010;21:126–32.CrossRefPubMed
25.
Akoum NW, Daccarett M, McGann C, Segerson N, Vergara GR, Kuppahally S, et al. Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach. J Cardiovasc Electrophysiol. 2011;22:16–22.CrossRefPubMedCentralPubMed
26.
Judd RM, Lugo-Olivieri CH, Arai M, Kondo T, Croisille P, Lima JAC, et al. Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-day-old reperfused canine infarcts. Circulation. 1995;92:1902–10.CrossRefPubMed
27.
Malcolme-Lawes LC, Juli C, Karim R, Bai W, Quest R, Lim PB, et al. Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: a 2-center study. Heart Rhythm. 2013;10:1184–91.CrossRefPubMedCentralPubMed
28.
Harrison JL, Sohns C, Linton NW, Karim R, Williams SE, Rhode KS, et al. Repeat left atrial catheter ablation: cardiac magnetic resonance prediction of endocardial voltage and gaps in ablation lesion sets. Circ Arrhythm Electrophysiol. 2015.
29.••
Hunter RJ, Jones DA, Boubertakh R, Malcolme-Lawes LC, Kanagaratnam P, Juli CF, et al. Diagnostic accuracy of cardiac magnetic resonance imaging in the detection and characterization of left atrial catheter ablation lesions: a multicenter experience. J Cardiovasc Electrophysiol. 2013;24:396–403. This study demonstrates that when examining CMR imaging taken post ablation, LGE scar imaging is not yet accurate enough to reliably identify ablation lesions or determine their distribution. This important study from two centres of excellence raises a note of caution in the interpretation of the growing body of work reporting increasingly accurate scar identification using CMR.CrossRefPubMed
Metadata
Title
Advances in CMR of Post-ablation Atrial Injury
Authors
James L. Harrison
John Whitaker
Henry Chubb
Steven E. Williams
Matthew Wright
Reza S. Razavi
Mark D. O’Neill
Publication date
01-06-2015
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 6/2015
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-015-9336-y

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