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Bijvoet GP, Nies HMJM, Holtackers RJ, Martens BM, Smink J, Linz D, Vernooy K, Wildberger JE, Nijveldt R, Chaldoupi SM, Mihl C. Tissue characterization of acute lesions during cardiac magnetic resonance-guided ablation of cavo-tricuspid isthmus-dependent atrial flutter: a feasibility study. Eur Heart J Cardiovasc Imaging 2024; 25:635-644. [PMID: 38156446 PMCID: PMC11057941 DOI: 10.1093/ehjci/jead334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/18/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
AIMS To characterize acute lesions during cardiac magnetic resonance (CMR)-guided radiofrequency (RF) ablation of cavo-tricuspid isthmus (CTI)-dependent atrial flutter by combining T2-weighted imaging (T2WI), T1 mapping, first-pass perfusion, and late gadolinium enhancement (LGE) imaging. CMR-guided catheter ablation offers a unique opportunity to investigate acute ablation lesions. Until present, studies only used T2WI and LGE CMR to assess acute lesions. METHODS AND RESULTS Fifteen patients with CTI-dependent atrial flutter scheduled for CMR-guided RF ablation were prospectively enrolled. Directly after achieving bidirectional block of the CTI line, CMR imaging was performed using: T2WI (n = 15), T1 mapping (n = 10), first-pass perfusion (n = 12), and LGE (n = 12) imaging. In case of acute reconnection, additional RF ablation was performed. In all patients, T2WI demonstrated oedema in the ablation region. Right atrial T1 mapping was feasible and could be analysed with a high inter-observer agreement (r = 0.931, ICC 0.921). The increase in T1 values post-ablation was significantly lower in regions showing acute reconnection compared with regions without reconnection [37 ± 90 ms vs. 115 ± 69 ms (P = 0.014), and 3.9 ± 9.0% vs. 11.1 ± 6.8% (P = 0.022)]. Perfusion defects were present in 12/12 patients. The LGE images demonstrated hyper-enhancement with a central area of hypo-enhancement in 12/12 patients. CONCLUSION Tissue characterization of acute lesions during CMR-guided CTI-dependent atrial flutter ablation demonstrates oedema, perfusion defects, and necrosis with a core of microvascular damage. Right atrial T1 mapping is feasible, and may identify regions of acute reconnection that require additional RF ablation.
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Affiliation(s)
- G P Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - H M J M Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B M Martens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J Smink
- Department of Clinical Research, Philips Healthcare, Best, The Netherlands
| | - D Linz
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Vernooy
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - J E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S M Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil and Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France and Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ngai-Yin Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, and Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas and Case Western Reserve University, Cleveland, Ohio and Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, USA
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina, USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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4
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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5
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Guglielmo M, Rier S, Zan GD, Krafft AJ, Schmidt M, Kunze KP, Botnar RM, Prieto C, van der Heijden J, Van Driel V, Ramanna H, van der Harst P, van der Bilt I. Cardiac magnetic resonance for early atrial lesion visualization post atrial fibrillation radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2024; 35:258-266. [PMID: 38065834 DOI: 10.1111/jce.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Incomplete atrial lesions resulting in pulmonary vein-left atrium reconnection after pulmonary vein antrum isolation (PVAI), are related to atrial fibrillation (AF) recurrence. Unfortunately, during the PVAI procedure, fluoroscopy and electroanatomic mapping cannot accurately determine the location and size of the ablation lesions in the atrial wall and this can result in incomplete PVAI lesions (PVAI-L) after radiofrequency catheter ablation (RFCA). AIM We seek to evaluate whether cardiac magnetic resonance (CMR), immediately after RFCA of AF, can identify PVAI-L by characterizing the left atrial tissue. METHODS Ten patients (63.1 ± 5.7 years old, 80% male) receiving a RFCA for paroxysmal AF underwent a CMR before (<1 week) and after (<1 h) the PVAI. Two-dimensional dark-blood T2-weighted short tau inversion recovery (DB-STIR), Three-dimensional inversion-recovery prepared long inversion time (3D-TWILITE) and three-dimensional late gadolinium enhancement (3D-LGE) images were performed to visualize PVAI-L. RESULTS The PVAI-L was visible in 10 patients (100%) using 3D-TWILITE and 3D-LGE. Conversely, On DB-STIR, the ablation core of the PAVI-L could not be identified because of a diffuse high signal of the atrial wall post-PVAI. Microvascular obstruction was identified in 7 (70%) patients using 3D-LGE. CONCLUSION CMR can visualize PVAI-L immediately after the RFCA of AF even without the use of contrast agents. Future studies are needed to understand if the use of CMR for PVAI-L detection after RFCA can improve the results of ablation procedures.
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Affiliation(s)
- Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Sophie Rier
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Giulia De Zan
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | | | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | - Rene M Botnar
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | - Claudia Prieto
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | | | - Vincent Van Driel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
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6
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Lyu Y, Bennamoun M, Sharif N, Lip GYH, Dwivedi G. Artificial Intelligence in the Image-Guided Care of Atrial Fibrillation. Life (Basel) 2023; 13:1870. [PMID: 37763273 PMCID: PMC10532509 DOI: 10.3390/life13091870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Atrial fibrillation arises mainly due to abnormalities in the cardiac conduction system and is associated with anatomical remodeling of the atria and the pulmonary veins. Cardiovascular imaging techniques, such as echocardiography, computed tomography, and magnetic resonance imaging, are crucial in the management of atrial fibrillation, as they not only provide anatomical context to evaluate structural alterations but also help in determining treatment strategies. However, interpreting these images requires significant human expertise. The potential of artificial intelligence in analyzing these images has been repeatedly suggested due to its ability to automate the process with precision comparable to human experts. This review summarizes the benefits of artificial intelligence in enhancing the clinical care of patients with atrial fibrillation through cardiovascular image analysis. It provides a detailed overview of the two most critical steps in image-guided AF management, namely, segmentation and classification. For segmentation, the state-of-the-art artificial intelligence methodologies and the factors influencing the segmentation performance are discussed. For classification, the applications of artificial intelligence in the diagnosis and prognosis of atrial fibrillation are provided. Finally, this review also scrutinizes the current challenges hindering the clinical applicability of these methods, with the aim of guiding future research toward more effective integration into clinical practice.
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Affiliation(s)
- Yiheng Lyu
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA 6009, Australia
| | - Mohammed Bennamoun
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
| | - Naeha Sharif
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 3BX, UK
- Liverpool John Moores University, Liverpool L3 5UX, UK
- Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA 6009, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA 6150, Australia
- Medical School, The University of Western Australia, Perth, WA 6009, Australia
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7
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De Zan G, Calò L, Borrelli A, Guglielmo M, De Ruvo E, Rier S, van Driel V, Ramanna H, Patti G, Rebecchi M, Fusco A, Stefanini M, Simonetti G, van der Bilt I. Cardiac magnetic resonance-guided cardiac ablation: a case series of an early experience. Eur Heart J Suppl 2023; 25:C265-C270. [PMID: 37125279 PMCID: PMC10132610 DOI: 10.1093/eurheartjsupp/suad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Radiofrequency (RF) catheter ablation has become a widely used therapeutic approach. However, long-term results in terms of arrhythmia recurrence are still suboptimal. Cardiac magnetic resonance (CMR) could offer a valuable tool to overcome this limitation, with the possibility of targeting the arrhythmic substrate and evaluating the location, depth, and possible gaps of RF lesions. Moreover, real-time CMR-guided procedures offer a radiation-free approach with an evaluation of anatomical structures, substrates, RF lesions, and possible complications during a single procedure. The first steps in the field have been made with cavotricuspid isthmus ablation, showing similar procedural duration and success rate to standard fluoroscopy-guided procedures, while allowing visualization of anatomic structures and RF lesions. These promising results open the path for further studies in the context of more complex arrhythmias, like atrial fibrillation and ventricular tachycardias. Of note, setting up an interventional CMR (iCMR) centre requires safety and technical standards, mostly related to the need for CMR-compatible equipment and medical staff's educational training. For the cardiac imagers, it is fundamental to provide correct CMR sequences for catheter tracking and guide RF delivery. At the same time, the electrophysiologist needs a rapid interpretation of CMR images during the procedures. The aim of this paper is first to review the logistic and technical aspects of setting up an iCMR suite. Then, we will describe the experience in iCMR-guided flutter ablations of two European centres, Policlinico Casilino in Rome, Italy, and Haga Teaching Hospital in The Hague, the Netherlands.
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Affiliation(s)
- Giulia De Zan
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Corso Mazzini 18, Novara 28100, Italy
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy
| | - Alessio Borrelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy
| | - Marco Guglielmo
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Ermenegildo De Ruvo
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy
| | - Sophie Rier
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Vincent van Driel
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Hemanth Ramanna
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
- Department of Medical Technology, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, The Hague 2521 EN, The Netherlands
| | - Giuseppe Patti
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Corso Mazzini 18, Novara 28100, Italy
| | - Marco Rebecchi
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy
| | - Armando Fusco
- Department of Radiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy
| | - Matteo Stefanini
- Department of Radiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy
| | - Giovanni Simonetti
- Department of Radiology, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy
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8
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Mont L, Roca-Luque I, Althoff TF. Ablation Lesion Assessment with MRI. Arrhythm Electrophysiol Rev 2022; 11:e02. [PMID: 35444808 PMCID: PMC9014705 DOI: 10.15420/aer.2021.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Late gadolinium enhancement (LGE) MRI is capable of detecting not only native cardiac fibrosis, but also ablation-induced scarring. Thus, it offers the unique opportunity to assess ablation lesions non-invasively. In the atrium, LGE-MRI has been shown to accurately detect and localise gaps in ablation lines. With a negative predictive value close to 100% it can reliably rule out pulmonary vein reconnection non-invasively and thus may avoid unnecessary invasive repeat procedures where a pulmonary vein isolation only approach is pursued. Even LGE-MRI-guided repeat pulmonary vein isolation has been demonstrated to be feasible as a standalone approach. LGE-MRI-based lesion assessment may also be of value to evaluate the efficacy of ventricular ablation. In this respect, the elimination of LGE-MRI-detected arrhythmogenic substrate may serve as a potential endpoint, but validation in clinical studies is lacking. Despite holding great promise, the widespread use of LGE-MRI is still limited by the absence of standardised protocols for image acquisition and post-processing. In particular, reproducibility across different centres is impeded by inconsistent thresholds and internal references to define fibrosis. Thus, uniform methodological and analytical standards are warranted to foster a broader implementation in clinical practice.
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Affiliation(s)
- Lluís Mont
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Cardiology and Angiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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9
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Li L, Zimmer VA, Schnabel JA, Zhuang X. Medical image analysis on left atrial LGE MRI for atrial fibrillation studies: A review. Med Image Anal 2022; 77:102360. [PMID: 35124370 PMCID: PMC7614005 DOI: 10.1016/j.media.2022.102360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
Late gadolinium enhancement magnetic resonance imaging (LGE MRI) is commonly used to visualize and quantify left atrial (LA) scars. The position and extent of LA scars provide important information on the pathophysiology and progression of atrial fibrillation (AF). Hence, LA LGE MRI computing and analysis are essential for computer-assisted diagnosis and treatment stratification of AF patients. Since manual delineations can be time-consuming and subject to intra- and inter-expert variability, automating this computing is highly desired, which nevertheless is still challenging and under-researched. This paper aims to provide a systematic review on computing methods for LA cavity, wall, scar, and ablation gap segmentation and quantification from LGE MRI, and the related literature for AF studies. Specifically, we first summarize AF-related imaging techniques, particularly LGE MRI. Then, we review the methodologies of the four computing tasks in detail and summarize the validation strategies applied in each task as well as state-of-the-art results on public datasets. Finally, the possible future developments are outlined, with a brief survey on the potential clinical applications of the aforementioned methods. The review indicates that the research into this topic is still in the early stages. Although several methods have been proposed, especially for the LA cavity segmentation, there is still a large scope for further algorithmic developments due to performance issues related to the high variability of enhancement appearance and differences in image acquisition.
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Affiliation(s)
- Lei Li
- School of Data Science, Fudan University, Shanghai, China; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Veronika A Zimmer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Informatics, Technical University of Munich, Germany
| | - Julia A Schnabel
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Informatics, Technical University of Munich, Germany; Helmholtz Center Munich, Germany
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China.
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10
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Bauer BK, Meier C, Bietenbeck M, Lange PS, Eckardt L, Yilmaz A. Cardiovascular Magnetic Resonance-Guided Radiofrequency Ablation: Where Are We Now? JACC Clin Electrophysiol 2022; 8:261-274. [PMID: 35210090 DOI: 10.1016/j.jacep.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
The possibilities of cardiovascular magnetic resonance (CMR) imaging for myocardial tissue characterization and catheter ablation guidance are accompanied by some fictional concepts. In this review, we present the available facts about CMR-guided catheter ablation procedures as well as promising, however unproven, theoretical concepts. CMR promises to visualize the respective arrhythmogenic substrate and may thereby make it more localizable for electrophysiology (EP)-based ablation. Robust CMR imaging is challenged by motion of the heart resulting from cardiac and respiratory cycles. In contrast to conventional "passive" tracking of the catheter tip by real-time CMR, novel approaches based on "active" tracking are performed by integrating microcoils into the catheter tip that send a receiver signal. Several experimental and clinical studies were already performed based on real-time CMR for catheter ablation of atrial and ventricular arrhythmias. Importantly, successful ablation of the cavotricuspid isthmus was already performed in patients with typical atrial flutter. However, a complete EP procedure with real-time CMR-guided transseptal puncture and subsequent pulmonary vein isolation has not been shown so far in patients with atrial fibrillation. Moreover, real-time CMR-guided EP for ventricular tachycardia ablation was only performed in animal models using a transseptal, retrograde, or epicardial access-but not in humans. Essential improvements within the next few years regarding basic technical requirements, such as higher spatial and temporal resolution of real-time CMR imaging as well as clinically approved cardiac magnetic resonance-conditional defibrillators, are ultimately required-but can also be expected-and will move this field forward.
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Affiliation(s)
- Bastian Klemens Bauer
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Claudia Meier
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany.
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11
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El Hajjar AH, Huang C, Zhang Y, Mekhael M, Noujaim C, Dagher L, Nedunchezhian S, Pottle C, Kholmovski E, Ayoub T, Dhorepatil A, Barakat M, Yamaguchi T, Chelu M, Marrouche N. Acute Lesion Imaging in Predicting Chronic Tissue Injury in the Ventricles. Front Cardiovasc Med 2022; 8:791217. [PMID: 35155604 PMCID: PMC8831749 DOI: 10.3389/fcvm.2021.791217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Chronic lesion formation after cardiac tissue ablation is an important indicator for procedural outcome. Moreover, there is a lack of knowledge regarding the features that predict chronic lesion formation. Objective The aim of this study is to determine whether acute lesion visualization using late gadolinium enhanced magnetic resonance imaging (LGE-MRI) can reliably predict chronic lesion size. Methods Focal lesions were created in left and right ventricles of canine models using either radiofrequency (RF) ablation or cryofocal ablation. Multiple ablation parameters were used. The first LGE-MRI was acquired within 1–5 h post-ablation and the second LGE-MRI was obtained 47–82 days later. Corview software was used to perform lesion segmentations and size calculations. Results: Fifty-Five lesions were created in different locations in the ventricles. Chronic volume size decreased by a mean of 62.5 % (95% CI 58.83–67.97, p < 0.0005). Similar regression of lesion volume was observed regardless of ablation location (p = 0.32), ablation technique (p = 0.94), duration (p = 0.37), power (p = 0.55) and whether lesions were connected or not (p = 0.35). There was no significant difference in lesion volume reduction assessed at 47–54 days and 72–82 days after ablation (p = 0.31). Chronic lesion volume was equal to 0.32 of the acute lesion volumes (R2 = 0.75). Conclusion Chronic tissue injury related to catheter ablation can be reliably modeled as a linear function of the acute lesion volume as assessed by LGE-MRI, regardless of the ablation parameters.
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Affiliation(s)
- Abdel Hadi El Hajjar
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Chao Huang
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Yichi Zhang
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Mario Mekhael
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Charbel Noujaim
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Lilas Dagher
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Saihariharan Nedunchezhian
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Christopher Pottle
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Eugene Kholmovski
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Tarek Ayoub
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Aneesh Dhorepatil
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Michel Barakat
- Department of Cardiology, PeaceHealth, Bellingham, WA, United States
| | | | - Mihail Chelu
- Baylor Heart Clinic, Baylor College of Medicine, Houston, TX, United States
| | - Nassir Marrouche
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
- *Correspondence: Nassir Marrouche
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12
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El‐Harasis MA, Richardson TD. Can Dark Core Lesions on Cardiac MRI Shed Some Light on Recurrence After VT Ablation? J Cardiovasc Electrophysiol 2022; 33:722-724. [DOI: 10.1111/jce.15381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Majd A. El‐Harasis
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Travis D. Richardson
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTNUSA
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13
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Park SY, Singh-Moon R, Yang H, Saluja D, Hendon C. Quantification of irrigated lesion morphology using near-infrared spectroscopy. Sci Rep 2021; 11:20160. [PMID: 34635764 PMCID: PMC8505541 DOI: 10.1038/s41598-021-99725-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022] Open
Abstract
There are currently limited means by which lesion formation can be confirmed during radiofrequency ablation procedures. The purpose of this study was to evaluate the use of NIRS-integrated RFA catheters for monitoring irrigated lesion progression, ex vivo and in vivo. Open-irrigated NIRS-ablation catheters with optical fibers were fabricated to sample tissue diffuse reflectance. Spectra from 44 irrigated lesions and 44 non-lesion sites from ex vivo swine hearts (n = 15) were used to train and evaluate a predictive model for lesion dimensions based on key spectral features. Additional studies were performed in diluted blood to assess NIRS signatures of catheter-tissue contact status. Finally, the potential of NIRS-RFA catheters for guiding lesion delivery was evaluated in a set of in vivo pilot studies conducted in healthy pigs (n = 4). Model predictions for lesion depth (R = 0.968), width (R = 0.971), and depth percentage (R = 0.924) correlated well with measured lesion dimensions. In vivo deployment in preliminary trials showed robust translational consistency of contact discrimination (P < 0.0001) and lesion depth parameters (< 3% error). NIRS empowered catheters are well suited for monitoring myocardial response to RF ablation and may provide useful intraprocedural feedback for optimizing treatment efficacy alongside current practices.
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Affiliation(s)
- Soo Young Park
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA
| | - Rajinder Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA
| | - Haiqiu Yang
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA
| | - Deepak Saluja
- Department of Medicine (Cardiology), Columbia University College of Physicians and Surgeons, 630 W. 168th St, New York, NY, 10032, USA
| | - Christine Hendon
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA.
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14
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Gottlieb LA, Dekker LRC, Coronel R. The Blinding Period Following Ablation Therapy for Atrial Fibrillation: Proarrhythmic and Antiarrhythmic Pathophysiological Mechanisms. JACC Clin Electrophysiol 2021; 7:416-430. [PMID: 33736761 DOI: 10.1016/j.jacep.2021.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 02/01/2023]
Abstract
Atrial fibrillation (AF) causes heart failure, ischemic strokes, and poor quality of life. The number of patients with AF is estimated to increase to 18 million in Europe in 2050. Pharmacological therapy does not cure AF in all patients. Ablative pulmonary vein isolation is recommended for patients with drug-resistant symptomatic paroxysmal AF but is successful in only about 60%. In patients in whom ablative therapy is successful on the long term, recurrence of AF may occur in the first weeks to months after pulmonary vein ablation. The early recurrence (or delayed cure) of AF is not understood but forms the basis for the generally accepted 3-month blinding (or blanking) period after ablation therapy, which is not included in the evaluation of the eventual success rate of the procedures. The underlying pathophysiological processes responsible for early recurrence and the delayed cure are unknown. The implicit assumption of the blinding period is that the AF mechanism in this period is different from the ablation-targeted AF mechanism (ectopy from the pulmonary veins). In this review, we evaluate the temporary and long-lasting pro- and antiarrhythmic effects of each of the pathophysiological processes and interventions (necrosis, ischemia, oxidative stress, edema, inflammation, autonomic nervous activity, tissue repair, mechanical remodeling, and use of antiarrhythmic drugs) occurring in the blinding period that can modulate AF mechanisms. We propose that stretch-reducing ablation scar is a permanent antiarrhythmic mechanism that develops during the blinding period and is the reason for delayed cure.
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Affiliation(s)
- Lisa A Gottlieb
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lukas R C Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands; Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands.
| | - Ruben Coronel
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
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15
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Nakatani Y, Sridi-Cheniti S, Cheniti G, Ramirez FD, Goujeau C, André C, Nakashima T, Eggert C, Schneider C, Viswanathan R, Krisai P, Takagi T, Kamakura T, Vlachos K, Derval N, Duchateau J, Pambrun T, Chauvel R, Reddy VY, Montaudon M, Laurent F, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation. Europace 2021; 23:1767-1776. [PMID: 34240134 PMCID: PMC8576285 DOI: 10.1093/europace/euab155] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 05/27/2021] [Indexed: 12/18/2022] Open
Abstract
Aims Pulsed field ablation (PFA), a non-thermal ablative modality, may show different effects on the myocardial tissue compared to thermal ablation. Thus, this study aimed to compare the left atrial (LA) structural and mechanical characteristics after PFA vs. thermal ablation. Methods and results Cardiac magnetic resonance was performed pre-ablation, acutely (<3 h), and 3 months post-ablation in 41 patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein (PV) isolation with PFA (n = 18) or thermal ablation (n = 23, 16 radiofrequency ablations, 7 cryoablations). Late gadolinium enhancement (LGE), T2-weighted, and cine images were analysed. In the acute stage, LGE volume was 60% larger after PFA vs. thermal ablation (P < 0.001), and oedema on T2 imaging was 20% smaller (P = 0.002). Tissue changes were more homogeneous after PFA than after thermal ablation, with no sign of microvascular damage or intramural haemorrhage. In the chronic stage, the majority of acute LGE had disappeared after PFA, whereas most LGE persisted after thermal ablation. The maximum strain on PV antra, the LA expansion index, and LA active emptying fraction declined acutely after both PFA and thermal ablation but recovered at the chronic stage only with PFA. Conclusion Pulsed field ablation induces large acute LGE without microvascular damage or intramural haemorrhage. Most LGE lesions disappear in the chronic stage, suggesting a specific reparative process involving less chronic fibrosis. This process may contribute to a preserved tissue compliance and LA reservoir and booster pump functions.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Soumaya Sridi-Cheniti
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Clementine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | | | | | | | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Konstantinos Vlachos
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Vivek Y Reddy
- Department of Cardiac Arrhythmia, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michel Montaudon
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - François Laurent
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
| | - Hubert Cochet
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU LIRYC-CHU Bordeaux/Univ. Bordeaux/Inserm U1045, Pessac, France
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16
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Sohns C, Marrouche NF. Atrial fibrillation and cardiac fibrosis. Eur Heart J 2021; 41:1123-1131. [PMID: 31713590 DOI: 10.1093/eurheartj/ehz786] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 12/25/2022] Open
Abstract
The understanding of atrial fibrillation (AF) evolved from a sole rhythm disturbance towards the complex concept of a cardiomyopathy based on arrhythmia substrates. There is evidence that atrial fibrosis can be visualized using late gadolinium enhancement cardiac magnetic resonance imaging and that it is a powerful predictor for the outcome of AF interventions. However, a strategy of an individual and fibrosis guided management of AF looks promising but results from prospective multicentre trials are pending. This review gives an overview about the relationship between cardiac fibrosis and AF focusing on translational aspects, clinical observations, and fibrosis imaging to emphasize the concept of personalized paths in AF management taking into account the individual amount and distribution of fibrosis.
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Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Nassir F Marrouche
- Cardiac Electrophysiology, Tulane University School of Medicine, 1430 Tulane Avenue, Box 8548, New Orleans, LA 70112, USA
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17
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Xiong Z, Xia Q, Hu Z, Huang N, Bian C, Zheng Y, Vesal S, Ravikumar N, Maier A, Yang X, Heng PA, Ni D, Li C, Tong Q, Si W, Puybareau E, Khoudli Y, Géraud T, Chen C, Bai W, Rueckert D, Xu L, Zhuang X, Luo X, Jia S, Sermesant M, Liu Y, Wang K, Borra D, Masci A, Corsi C, de Vente C, Veta M, Karim R, Preetha CJ, Engelhardt S, Qiao M, Wang Y, Tao Q, Nuñez-Garcia M, Camara O, Savioli N, Lamata P, Zhao J. A global benchmark of algorithms for segmenting the left atrium from late gadolinium-enhanced cardiac magnetic resonance imaging. Med Image Anal 2021; 67:101832. [PMID: 33166776 DOI: 10.1016/j.media.2020.101832] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
Segmentation of medical images, particularly late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) used for visualizing diseased atrial structures, is a crucial first step for ablation treatment of atrial fibrillation. However, direct segmentation of LGE-MRIs is challenging due to the varying intensities caused by contrast agents. Since most clinical studies have relied on manual, labor-intensive approaches, automatic methods are of high interest, particularly optimized machine learning approaches. To address this, we organized the 2018 Left Atrium Segmentation Challenge using 154 3D LGE-MRIs, currently the world's largest atrial LGE-MRI dataset, and associated labels of the left atrium segmented by three medical experts, ultimately attracting the participation of 27 international teams. In this paper, extensive analysis of the submitted algorithms using technical and biological metrics was performed by undergoing subgroup analysis and conducting hyper-parameter analysis, offering an overall picture of the major design choices of convolutional neural networks (CNNs) and practical considerations for achieving state-of-the-art left atrium segmentation. Results show that the top method achieved a Dice score of 93.2% and a mean surface to surface distance of 0.7 mm, significantly outperforming prior state-of-the-art. Particularly, our analysis demonstrated that double sequentially used CNNs, in which a first CNN is used for automatic region-of-interest localization and a subsequent CNN is used for refined regional segmentation, achieved superior results than traditional methods and machine learning approaches containing single CNNs. This large-scale benchmarking study makes a significant step towards much-improved segmentation methods for atrial LGE-MRIs, and will serve as an important benchmark for evaluating and comparing the future works in the field. Furthermore, the findings from this study can potentially be extended to other imaging datasets and modalities, having an impact on the wider medical imaging community.
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Affiliation(s)
- Zhaohan Xiong
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Qing Xia
- State Key Lab of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Zhiqiang Hu
- School of Electronics Engineering and Computer Science, Peking University, Beijing, China
| | | | - Cheng Bian
- Tencent Jarvis Laboratory, Shenzhen, China
| | | | - Sulaiman Vesal
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nishant Ravikumar
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Xin Yang
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Caizi Li
- School of Computer Science, Wuhan University, Wuhan, China
| | - Qianqian Tong
- School of Computer Science, Wuhan University, Wuhan, China
| | - Weixin Si
- Shenzhen Key Laboratory of Virtual Reality and Human Interaction Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | | | - Younes Khoudli
- EPITA Research and Development Laboratory, Paris, France
| | - Thierry Géraud
- EPITA Research and Development Laboratory, Paris, France
| | - Chen Chen
- Department of Computing, Imperial College London, London, United Kingdom
| | - Wenjia Bai
- Department of Computing, Imperial College London, London, United Kingdom
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, United Kingdom
| | - Lingchao Xu
- School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China
| | - Xinzhe Luo
- School of Data Science, Fudan University, Shanghai, China
| | - Shuman Jia
- Inria, Université Côte d'Azur, Epione team, Sophia Antipolis, France
| | - Maxime Sermesant
- Inria, Université Côte d'Azur, Epione team, Sophia Antipolis, France
| | - Yashu Liu
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Kuanquan Wang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Davide Borra
- Department of Electric, Electronic and Information Engineering, University of Bologna, Cesena, Italy
| | - Alessandro Masci
- Department of Electric, Electronic and Information Engineering, University of Bologna, Cesena, Italy
| | - Cristiana Corsi
- Department of Electric, Electronic and Information Engineering, University of Bologna, Cesena, Italy
| | - Coen de Vente
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Mitko Veta
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Rashed Karim
- School of Biomedical Engineering & Imaging Sciences, Kings College London, London, United Kingdom
| | | | - Sandy Engelhardt
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - Menyun Qiao
- Biomedical Engineering Center, Fudan University, Shanghai, China
| | - Yuanyuan Wang
- Biomedical Engineering Center, Fudan University, Shanghai, China
| | - Qian Tao
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marta Nuñez-Garcia
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Camara
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Nicolo Savioli
- Department of Bioengineering, Kings College London, London, United Kingdom
| | - Pablo Lamata
- Department of Bioengineering, Kings College London, London, United Kingdom
| | - Jichao Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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18
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Abstract
AF is the most common arrhythmia in clinical practice. In addition to the severe effect on quality of life, patients with AF are at higher risk of stroke and mortality. Recent studies have suggested that atrial and ventricular substrate play a major role in the development and maintenance of AF. Cardiac MRI has emerged as a viable tool for interrogating the underlying substrate in AF patients. Its advantage includes localisation and quantification of structural remodelling. Cardiac MRI of the atrial substrate is not only a tool for management and treatment of arrhythmia, but also to individualise the prevention of stroke and major cardiovascular events. This article provides an overview of atrial imaging using cardiac MRI and its clinical implications in the AF population.
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Affiliation(s)
- Yan Zhao
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Lilas Dagher
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Chao Huang
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Peter Miller
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Nassir F Marrouche
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
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19
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Ali RL, Qureshi NA, Liverani S, Roney CH, Kim S, Lim PB, Tweedy JH, Cantwell CD, Peters NS. Left Atrial Enhancement Correlates With Myocardial Conduction Velocity in Patients With Persistent Atrial Fibrillation. Front Physiol 2020; 11:570203. [PMID: 33304272 PMCID: PMC7693630 DOI: 10.3389/fphys.2020.570203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Conduction velocity (CV) heterogeneity and myocardial fibrosis both promote re-entry, but the relationship between fibrosis as determined by left atrial (LA) late-gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMRI) and CV remains uncertain. OBJECTIVE Although average CV has been shown to correlate with regional LGE-CMRI in patients with persistent AF, we test the hypothesis that a localized relationship exists to underpin LGE-CMRI as a minimally invasive tool to map myocardial conduction properties for risk stratification and treatment guidance. METHOD 3D LA electroanatomic maps during LA pacing were acquired from eight patients with persistent AF following electrical cardioversion. Local CVs were computed using triads of concurrently acquired electrograms and were co-registered to allow correlation with LA wall intensities obtained from LGE-CMRI, quantified using normalized intensity (NI) and image intensity ratio (IIR). Association was evaluated using multilevel linear regression. RESULTS An association between CV and LGE-CMRI intensity was observed at scales comparable to the size of a mapping electrode: -0.11 m/s per unit increase in NI (P < 0.001) and -0.96 m/s per unit increase in IIR (P < 0.001). The magnitude of this change decreased with larger measurement area. Reproducibility of the association was observed with NI, but not with IIR. CONCLUSION At clinically relevant spatial scales, comparable to area of a mapping catheter electrode, LGE-CMRI correlates with CV. Measurement scale is important in accurately quantifying the association of CV and LGE-CMRI intensity. Importantly, NI, but not IIR, accounts for changes in the dynamic range of CMRI and enables quantitative reproducibility of the association.
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Affiliation(s)
- Rheeda L. Ali
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Norman A. Qureshi
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Silvia Liverani
- School of Mathematical Sciences, Queen Mary University of London, London, United Kingdom
| | - Caroline H. Roney
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Steven Kim
- Abbot Medical, St. Paul, MN, United States
| | - P. Boon Lim
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Jennifer H. Tweedy
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Chris D. Cantwell
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- Department of Aeronautics, Imperial College London, London, United Kingdom
| | - Nicholas S. Peters
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
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20
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Obeng-Gyimah E, Nazarian S. Advancements in Imaging for Atrial Fibrillation Ablation: Is There a Potential to Improve Procedural Outcomes? J Innov Card Rhythm Manag 2020; 11:4172-4178. [PMID: 32724708 PMCID: PMC7377648 DOI: 10.19102/icrm.2020.110701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Since the introduction of atrial fibrillation (AF) ablation in the 1990s, the procedure has continuously evolved, with gradual improvements in outcomes and safety. Recent technological advancements include the introduction of contact force catheters and high-resolution electroanatomical mapping systems, while imaging modalities including transesophageal echocardiography and fluoroscopy have become integral parts of AF ablation procedures. Further, intraprocedural intracardiac echocardiography and the integration of cardiac magnetic resonance and computed tomography images with electroanatomical mapping have shown promise to improve procedural outcomes by reducing radiation exposure and procedural times. However, available data on procedural utility and the reduction in AF recurrence rates associated with these modalities are mixed. This review therefore aims to discuss the current common imaging modalities used in AF ablation and their potential impact on outcomes. In particular, imaging is discussed with respect to the important information it offers before, during, and after the procedure. Perspectives on the future of imaging in AF ablation are also shared.
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Affiliation(s)
- Edmond Obeng-Gyimah
- Perelman Clinical Electrophysiology Section, Cardiovascular Division, Department of Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Saman Nazarian
- Perelman Clinical Electrophysiology Section, Cardiovascular Division, Department of Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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21
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Guttman MA, Tao S, Fink S, Tunin R, Schmidt EJ, Herzka DA, Halperin HR, Kolandaivelu A. Acute enhancement of necrotic radio-frequency ablation lesions in left atrium and pulmonary vein ostia in swine model with non-contrast-enhanced T 1 -weighted MRI. Magn Reson Med 2020; 83:1368-1379. [PMID: 31565818 PMCID: PMC6949368 DOI: 10.1002/mrm.28001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate non-contrast-enhanced MRI of acute radio-frequency ablation (RFA) lesions in the left atrium (LA) and pulmonary vein (PV) ostia. The goal is to provide a method for discrimination between necrotic (permanent) lesions and reversible injury, which is associated with recurrence after treatment of atrial fibrillation. METHODS Fifteen normal swine underwent RFA around the right-superior PV ostia. Electrical pulmonary vein isolation (PVI) was verified by electro-anatomic mapping (EAM) and pacing. MRI was carried out using a 3D respiratory-gated T1 -weighted long inversion time (TWILITE) sequence without contrast agent. Key settings were: inversion time 700 ms, triggering over 2 cardiac cycles, pixel size 1.1 mm3 . Contrast-enhanced imaging and T2 -weighted imaging were carried out for comparison. Six animals were sacrificed on ablation day for TTC-stained gross pathology, 9 animals were sacrificed after 2-3 mo after repeat EAM and MRI. Image intensity ratio (IIR) was used to measure lesion enhancement, and gross pathology was used to validate image enhancement patterns and compare lesion widths. RESULTS RFA lesions exhibited unambiguous enhancement in acute TWILITE imaging (IIR = 2.34 ± 0.49 at 1.5T), and the enhancement patterns corresponded well with gross pathology. Lesion widths in MRI correlated well with gross pathology (R2 = 0.84), with slight underestimation by 0.9 ± 0.5 mm. Lesion enhancement subsided chronically. CONCLUSION TWILITE imaging allowed acute detection of permanent RFA lesions in swine LA and PV ostia, without the need for contrast agent. Lesion enhancement pattern showed good correspondence to gross pathology and was well visualized by volume rendering. This method may provide valuable intra- or post-procedural assessment of RFA treatment.
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Affiliation(s)
- Michael A Guttman
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Susumu Tao
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah Fink
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rick Tunin
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ehud J Schmidt
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Daniel A Herzka
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry R Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Aravindan Kolandaivelu
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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22
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Vunnam R, Maheshwari V, Jeudy J, Ghzally Y, Imanli H, Abdulghani M, Mahat JB, Timilsina S, Restrepo A, See V, Shorofsky S, Dickfeld T. Ventricular arrhythmia ablation lesions detectability and temporal changes on cardiac magnetic resonance. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:314-321. [DOI: 10.1111/pace.13886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/09/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rama Vunnam
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Varun Maheshwari
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Jean Jeudy
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Department of Diagnostic Radiology and Nuclear MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Yousra Ghzally
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Hasan Imanli
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Mohammed Abdulghani
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Jagat B. Mahat
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Saroj Timilsina
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Alejandro Restrepo
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Vincent See
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Stephen Shorofsky
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
| | - Timm Dickfeld
- Maryland Arrhythmia and Cardiology Imaging Group Baltimore Maryland
- Division of Cardiology, Department of MedicineUniversity of Maryland School of Medicine Baltimore Maryland
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23
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Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR? Diagnostics (Basel) 2020; 10:diagnostics10030137. [PMID: 32131455 PMCID: PMC7151417 DOI: 10.3390/diagnostics10030137] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 12/28/2022] Open
Abstract
Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase “AF begets AF”. A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.
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24
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Aparina OP, Mironov NY, Fedorova EA, Dzaurova KM, Maikov EB, Stukalova OV, Golitsyn SP. [Cardiac magnetic resonance imaging with contrast enhancement in treatment of atrial fibrillation]. ACTA ACUST UNITED AC 2020; 60:119-125. [PMID: 32375624 DOI: 10.18087/cardio.2020.3.n582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
Catheter ablation is presently the main method for interventional treatment of atrial fibrillation (AF). Despite improvements of the method and accumulation of personnel's experience, incidence of recurrent AF following catheter interventions remains high. This review addresses a possibility of using contrast-enhanced cardiac magnetic resonance imaging to increase the effectiveness of interventional treatment of arrhythmia.
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Affiliation(s)
- O P Aparina
- National Medical Research Center of Cardiology
| | | | | | | | - E B Maikov
- National Medical Research Center of Cardiology
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Linhart M, Alarcon F, Borràs R, Benito EM, Chipa F, Cozzari J, Caixal G, Enomoto N, Carlosena A, Guasch E, Arbelo E, Tolosana JM, Prat-Gonzalez S, Perea RJ, Doltra A, Sitges M, Brugada J, Berruezo A, Mont L. Delayed Gadolinium Enhancement Magnetic Resonance Imaging Detected Anatomic Gap Length in Wide Circumferential Pulmonary Vein Ablation Lesions Is Associated With Recurrence of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006659. [PMID: 30562102 DOI: 10.1161/circep.118.006659] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited knowledge about the impact of anatomic gaps as assessed by delayed gadolinium enhancement cardiac magnetic resonance on atrial fibrillation (AF) recurrence after first pulmonary vein (PV) isolation. METHODS Consecutive patients underwent delayed gadolinium enhancement cardiac magnetic resonance 3 months after radiofrequency circumferential PV isolation. Delayed gadolinium enhancement cardiac magnetic resonance images were assessed from 360 PV resulting in 2880 segments in the 2×8-segment model from 94 patients (52±11 years, 62% paroxysmal AF). Left atria were segmented using dedicated software. Anatomic gap was defined as discontinuation of the ablation line by ≥3 mm. Relative gap length was calculated as absolute gap length divided by the total length of the ablation line. AF recurrence was assessed after a mean follow-up duration of 15±10 months Results: Mean number of anatomic gaps was 5.4 per patient. Recurrence within the first year of ablation was observed in 21 patients with paroxysmal AF (36%) and 19 patients with persistent AF (53%). In the univariate analysis, CHA2DS2-VASc score, AF type, and relative gap length were predictive of recurrence. In the multivariate analysis, only relative gap length was significantly associated with recurrence (hazard ratio, 1.16 [1.02-1.31] per each 10% of gap). CONCLUSIONS The total relative gap length but not the number of anatomic gaps in the PV ablation line as assessed by delayed gadolinium enhancement cardiac magnetic resonance was associated with AF recurrence 1 year after first PV isolation. An increase of 10% relative gap length increased the likelihood of AF recurrence by 16%.
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Affiliation(s)
- Markus Linhart
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Francisco Alarcon
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Roger Borràs
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Eva M Benito
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.)
| | - Fredy Chipa
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Jennifer Cozzari
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Gala Caixal
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Norihiro Enomoto
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Alicia Carlosena
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Eduard Guasch
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Elena Arbelo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Jose Maria Tolosana
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Susana Prat-Gonzalez
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.)
| | - Rosario J Perea
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Adelina Doltra
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Marta Sitges
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Josep Brugada
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Antonio Berruezo
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Lluís Mont
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
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Nazarian S, Marchlinski F. Dechanneling Left Atrial Late Gadolinium Enhancement: An Imaging Moon Shot? Circ Arrhythm Electrophysiol 2019; 12:e007683. [PMID: 31422687 DOI: 10.1161/circep.119.007683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saman Nazarian
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Francis Marchlinski
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Giannopoulos G, Kossyvakis C, Vrachatis D, Aggeli C, Tsitsinakis G, Letsas K, Tsiachris D, Tsoukala S, Efremidis M, Katritsis D, Deftereos S. Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo-LAEF study). J Cardiovasc Electrophysiol 2019; 30:991-998. [PMID: 30938914 DOI: 10.1111/jce.13933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/06/2019] [Accepted: 03/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Isolation of the pulmonary veins (PVI) has become a mainstay in atrial fibrillation (AFib) therapy. Lesions in left atrial tissue lead to scar formation and this may affect left atrial function. METHODS Patients with paroxysmal AFib were randomly assigned in a 1:2 allocation scheme to radiofrequency (RF) ablation or cryoballoon. Real-time three-dimensional echocardiography was performed (under sinus rhythm in all cases) before ablation and at 1 and 3 months to evaluate the left atrial functional indices. The primary outcome measure was change in left atrial ejection fraction (LAEF) at 1 month. RESULTS 120 patients were randomized (80 to cryoballoon, 40 to RF). The absolute change in LAEF at 1 month was 4.0 (Q1-Q3, -0.1to 7.6)% in the cryoballoon group and -0.8 (Q1-Q3, -1.9 to 0.9)% in the RF group (P < 0.001 for the comparison between groups). At 3 months, the corresponding changes were 6.7 (Q1-Q3, 3.4-11.2)% and 0.7 (Q1-Q3, -0.7 to 3.5)%, respectively (P < 0.001). Overall, the rate of patients with lower LAEF at 3 months compared to baseline was 2.5% in the cryoballoon group and 32.5% in the RF group (P < 0.001). AFib recurrence rate at 6 months was higher in patients with decreased LAEF (odds ratio, 6.2; 95% confidence interval, 2.0-19.5; P = 0.002). CONCLUSION The Cryo-LAEF study prospectively compared the effects of RF and cryoballoon ablation on left atrial function. Both at 1 and 3 months postablation, LAEF was either improved or stable in both ablation groups.
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Affiliation(s)
| | | | - Dimitrios Vrachatis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Constadina Aggeli
- 1st Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsitsinakis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | | | - Styliani Tsoukala
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Michalis Efremidis
- 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | | | - Spyridon Deftereos
- 1st Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Benito EM, Alarcon F, Mont L. LGE-MRI Characterization of Left Atrial Fibrosis: a Tool to Establish Prognosis and Guide Atrial Fibrillation Ablation. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tao S, Guttman MA, Fink S, Elahi H, Patil KD, Ashikaga H, Kolandaivelu AD, Berger RD, Halushka MK, Schmidt EJ, Herzka DA, Halperin HR. Ablation Lesion Characterization in Scarred Substrate Assessed Using Cardiac Magnetic Resonance. JACC Clin Electrophysiol 2018; 5:91-100. [PMID: 30678791 DOI: 10.1016/j.jacep.2018.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study examined radiofrequency catheter ablation (RFCA) lesions within and around scar by cardiac magnetic resonance (CMR) imaging and histology. BACKGROUND Substrate modification by RFCA is the cornerstone therapy for ventricular arrhythmias. RFCA in scarred myocardium, however, is not well understood. METHODS We performed electroanatomic mapping and RFCA in the left ventricles of 8 swine with myocardial infarction. Non-contrast-enhanced T1-weighted (T1w) and contrast-enhanced CMR after RFCA were compared with gross pathology and histology. RESULTS Of 59 lesions, 17 were in normal myocardium (voltage >1.5 mV), 21 in border zone (0.5 to 1.5 mV), and 21 in scar (<0.5 mV). All RFCA lesions were enhanced in T1w CMR, whereas scar was hypointense, allowing discrimination among normal myocardium, scar, and RFCA lesions. With contrast-enhancement, lesions and scar were similarly enhanced and not distinguishable. Lesion width and depth in T1w CMR correlated with necrosis in pathology (both; r2 = 0.94, p < 0.001). CMR lesion volume was significantly different in normal myocardium, border zone, and scar (median: 397 [interquartile range (IQR): 301 to 474] mm3, 121 [IQR: 87 to 201] mm3, 66 [IQR: 33 to 123] mm3, respectively). RFCA force-time integral, impedance, and voltage changes did not correlate with lesion volume in border zone or scar. Histology showed that ablation necrosis extended into fibrotic tissue in 26 lesions and beyond in 14 lesions. In 7 lesions, necrosis expansion was blocked and redirected by fat. CONCLUSIONS T1w CMR can selectively enhance necrotic tissue in and around scar and may allow determination of the completeness of ablation intra- and post-procedure. Lesion formation in scar is affected by tissue characteristics, with fibrosis and fat acting as thermal insulators.
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Affiliation(s)
- Susumu Tao
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Michael A Guttman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Fink
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hassan Elahi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kaustubha D Patil
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiroshi Ashikaga
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aravindan D Kolandaivelu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald D Berger
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc K Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ehud J Schmidt
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel A Herzka
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry R Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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New Insights Into the Use of Cardiac Magnetic Resonance Imaging to Guide Decision Making in Atrial Fibrillation Management. Can J Cardiol 2018; 34:1461-1470. [DOI: 10.1016/j.cjca.2018.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 12/13/2022] Open
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Dinov B, Oebel S, Hilbert S, Loebe S, Arya A, Bollmann A, Sommer P, Jahnke C, Paetsch I, Hindricks G. Characteristics of the ablation lesions in cardiac magnetic resonance imaging after radiofrequency ablation of ventricular arrhythmias in relation to the procedural success. Am Heart J 2018; 204:68-75. [PMID: 30077835 DOI: 10.1016/j.ahj.2018.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In human patients, studies about the cardiac magnetic resonance (CMR) appearance of the acute radiofrequency (RF) lesions in relation to the procedural outcomes after catheter ablation (CA) of ventricular arrhythmias (VA) are scarce. We aimed to investigate the RF lesions characteristics in relation to the procedural success. METHODS Patients referred for ablation of VA received CMR (1.5 T) using gadolinium contrast before and after ablation. CA in left ventricle was performed using a 3.5-mm irrigated catheter. The volume and transmurality of the RF-induced lesions were measured in early gadolinium-enhanced postablation CMRs. Acute failure was defined as persistently inducible VA at the end of the CA. RESULTS Twenty-five patients (60.7 ± 9.8 years, 19 with sustained ventricular tachycardia) were studied. All RF lesions had nonenhanced core. The volume of the nonenhanced lesions showed positive correlation with the maximal RF power (r = 0.598, P = .002) and the impedance drop (r = 0.416, P = .038). Patients with transmural (≥75%) lesions had significantly larger impedance drop as compared to those with nontransmural lesions (<75%): 20.3 ± 9.4 versus 13.5 ± 4.3, P = .037. In the failures, the lesions volume was nonsignificantly larger: 3.86 ± 3.3% versus 2.6 ± 1.7%, P = .197; however, it was considerably deeper: 86 ± 13% versus 62 ± 26%, P = .03. CONCLUSIONS CMR after VA ablation showed nonenhanced lesions resembling the no-reflow phenomenon in myocardial infarction. Although the size and the depth of the RF injury correlated with the ablation energy and impedance drop, they were not associated with acute ablation success.
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Kholmovski EG, Silvernagel J, Angel N, Vijayakumar S, Thomas S, Dosdall D, MacLeod R, Marrouche NF, Ranjan R. Acute noncontrast T1-weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions. J Cardiovasc Electrophysiol 2018; 29:1556-1562. [PMID: 30106244 DOI: 10.1111/jce.13709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been used to visualize radiofrequency (RF) ablation lesions but the relationship between volumes that enhance in acute MRI and the chronic lesion size is unknown. OBJECTIVES The main goal was to use noncontrast (native) T1-weighted (T1w) MRI and late gadolinium enhancement (LGE)-MRI to visualize lesions acutely and chronically and correlate the acute area of enhancement with chronic lesion size in histology. MATERIALS AND METHODS In a canine (n = 9) model RF ablation lesions were created in both ventricles. Native T1w MRI and LGE-MRI were acquired acutely after the ablation procedure. After 8 weeks, another set of RF ablations was performed, and the MRI study was repeated. Volume and depth of enhancement in native T1w MRI and LGE-MRI acquired after the initial ablation procedure were correlated with chronic lesion volume and depth in histology. RESULTS Thirty-three lesions were analyzed. Native T1w MRI visualized the acute lesions but not the chronic lesions. LGE-MRI showed both acute and chronic lesions. Acute native T1w MRI volume (average of 102.1 ± 48.5 mm3 ) and depth (4.9 ± 1.2 mm) correlated well with chronic histological volume (105.9 ± 51.8 mm3 ) and depth (4.8 ± 1.3 mm) with R2 of 0.881 (P < 0.001) and 0.874 (P < 0.001), respectively. Acute LGE-MRI had a significantly higher volume of enhancement of 499.7 ± 214.4 mm3 (P < 0.001) and depth of 7.5 ± 1.8 mm ( P < 0.001) when compared with chronic histological lesion volume and depth. CONCLUSIONS Native T1w MRI acquired acutely after RF ablation is a good predictor of chronic lesion size. Acute LGE-MRI significantly overestimates the chronic lesion size.
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Affiliation(s)
- Eugene G Kholmovski
- Division of Cardiovascular Medicine, CARMA Center, University of Utah, Salt Lake City, Utah.,Department of Radiology and Imaging Sciences, UCAIR, University of Utah, Salt Lake City, Utah
| | - Josh Silvernagel
- Department of Bioengineering, University of Utah, Salt Lake City, Utah.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Nathan Angel
- Department of Bioengineering, University of Utah, Salt Lake City, Utah.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Sathya Vijayakumar
- Division of Cardiovascular Medicine, CARMA Center, University of Utah, Salt Lake City, Utah.,Department of Radiology and Imaging Sciences, UCAIR, University of Utah, Salt Lake City, Utah
| | - Samuel Thomas
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Derek Dosdall
- Department of Bioengineering, University of Utah, Salt Lake City, Utah.,Department of Surgery, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Rob MacLeod
- Department of Bioengineering, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Nassir F Marrouche
- Division of Cardiovascular Medicine, CARMA Center, University of Utah, Salt Lake City, Utah.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Department of Bioengineering, University of Utah, Salt Lake City, Utah.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
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Schmidt EJ, Halperin HR. MRI use for atrial tissue characterization in arrhythmias and for EP procedure guidance. Int J Cardiovasc Imaging 2018; 34:81-95. [PMID: 28593399 PMCID: PMC5889521 DOI: 10.1007/s10554-017-1179-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/24/2017] [Indexed: 12/19/2022]
Abstract
We review the utilization of magnetic resonance imaging methods for classifying atrial tissue properties that act as a substrate for common cardiac arrhythmias, such as atrial fibrillation. We then review state-of-the-art methods for mapping this substrate as a predicate for treatment, as well as methods used to ablate the electrical pathways that cause arrhythmia and restore patients to sinus rhythm.
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Affiliation(s)
- Ehud J Schmidt
- Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Henry R Halperin
- Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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Ghafoori E, Kholmovski EG, Thomas S, Silvernagel J, Angel N, Hu N, Dosdall DJ, MacLeod R, Ranjan R. Characterization of Gadolinium Contrast Enhancement of Radiofrequency Ablation Lesions in Predicting Edema and Chronic Lesion Size. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005599. [PMID: 29079664 DOI: 10.1161/circep.117.005599] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been used to acutely visualize radiofrequency ablation lesions, but its accuracy in predicting chronic lesion size is unknown. The main goal of this study was to characterize different areas of enhancement in late gadolinium enhancement MRI done immediately after ablation to predict acute edema and chronic lesion size. METHODS AND RESULTS In a canine model (n=10), ventricular radiofrequency lesions were created using ThermoCool SmartTouch (Biosense Webster) catheter. All animals underwent MRI (late gadolinium enhancement and T2-weighted edema imaging) immediately after ablation and after 1, 2, 4, and 8 weeks. Edema, microvascular obstruction, and enhanced volumes were identified in MRI and normalized to chronic histological volume. Immediately after contrast administration, the microvascular obstruction region was 3.2±1.1 times larger than the chronic lesion volume in acute MRI. Even 60 minutes after contrast administration, edema was 8.7±3.31 times and the enhanced area 6.14±2.74 times the chronic lesion volume. Exponential fit to the microvascular obstruction volume was found to be the best predictor of chronic lesion volume at 26.14 minutes (95% prediction interval, 24.35-28.11 minutes) after contrast injection. The edema volume in late gadolinium enhancement correlated well with edema volume in T2-weighted MRI with an R2 of 0.99. CONCLUSION Microvascular obstruction region on acute late gadolinium enhancement images acquired 26.1 minutes after contrast administration can accurately predict the chronic lesion volume. We also show that T1-weighted MRI images acquired immediately after contrast injection accurately shows edema resulting from radiofrequency ablation.
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Affiliation(s)
- Elyar Ghafoori
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Eugene G Kholmovski
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Sam Thomas
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Josh Silvernagel
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Nathan Angel
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Nan Hu
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Derek J Dosdall
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Rob MacLeod
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City
| | - Ravi Ranjan
- From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
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Markman TM, Nazarian S. Cardiac Magnetic Resonance for Lesion Assessment in the Electrophysiology Laboratory. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005839. [PMID: 29079665 DOI: 10.1161/circep.117.005839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Timothy M Markman
- From the Division of Cardiology (T.M.M., S.N.) and Section for Cardiac Electrophysiology (S.N.), Hospital of the University of Pennsylvania, Philadelphia
| | - Saman Nazarian
- From the Division of Cardiology (T.M.M., S.N.) and Section for Cardiac Electrophysiology (S.N.), Hospital of the University of Pennsylvania, Philadelphia.
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Siebermair J, Kholmovski EG, Marrouche N. Assessment of Left Atrial Fibrosis by Late Gadolinium Enhancement Magnetic Resonance Imaging: Methodology and Clinical Implications. JACC Clin Electrophysiol 2017; 3:791-802. [PMID: 29759774 DOI: 10.1016/j.jacep.2017.07.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 12/12/2022]
Abstract
Recently, studies using late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) to identify structural changes of atrial tissue have contributed significantly to understanding the pathophysiology and progression of atrial fibrillation (AF). Moreover, imaging of atrial fibrosis using MRI has evolved to be a tool to improve clinical outcome of AF ablation procedures by allowing a patient-specific individualized management approach. LGE-MRI has been shown to predict AF ablation outcome based on pre-procedural imaging to define the extent of atrial fibrosis. The results of the ongoing DECAAF II (Delayed-Enhancement MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation) trial might extend ablation strategies from pulmonary vein isolation alone to a substrate-based approach. Furthermore, an improved understanding of the underlying mechanisms of atrial structural remodeling is crucial in order to reduce the occurrence of AF-associated complications (e.g., ischemic stroke and heart failure). This review article provides current methodology of atrial fibrosis imaging using LGE-MRI and delineates actual clinical implications and future directions for this imaging approach.
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Affiliation(s)
- Johannes Siebermair
- Comprehensive Arrhythmia and Research Management (CARMA) Center, University of Utah School of Medicine, Salt Lake City, Utah; Department of Medicine I, Klinikum Grosshadern, University of Munich, Munich, Germany; German Cardiovascular Research Center (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Eugene G Kholmovski
- Comprehensive Arrhythmia and Research Management (CARMA) Center, University of Utah School of Medicine, Salt Lake City, Utah; UCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Nassir Marrouche
- Comprehensive Arrhythmia and Research Management (CARMA) Center, University of Utah School of Medicine, Salt Lake City, Utah.
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Lam A, Okene E, Parikh A, Zhong X, Tejada T, Hoskins M, Lloyd M, Oshinski JN. Combined Angiography and Late Gadolinium Enhancement Acquisition to Improve Assessment of Pulmonary Vein Isolation for Atrial Fibrillation. J Magn Reson Imaging 2017; 47:477-486. [PMID: 28556294 DOI: 10.1002/jmri.25771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/09/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop a Shared K-space (SharK) magnetic resonance imaging (MRI) sequence that combines angiographic and late gadolinium enhancement (LGE) acquisitions to improve atrial wall segmentation and scar identification, and to develop a novel visualization method that quantifies scar encirclement of pulmonary veins postablation treatment for atrial fibrillation. MATERIALS AND METHODS A SharK sequence was developed and used at 3T to image the left atrium in 11 patients postcryoballoon ablation. The effects of sharing k-space between the angiographic and LGE acquisitions on the accuracy of scar were assessed. The left atrial wall was segmented and points about each pulmonary vein (PV) ostia were projected onto a bullseye to quantitatively compare PV encirclement. The parameters used to quantify encirclement were varied to perform a sensitivity analysis. RESULTS Compared to using a complete set of k-space, total atrial scar differences were significant only when sharing >75% k-space (P = 0.014), and 90% sensitivity and specificity for identifying scar was achieved when sharing 50% k-space. In patients, the right PVs showed more intersubject variance in encirclement compared to the left PVs. A 100° anteroinferior portion of the left PVs was always encircled, while the superior segments of both right PVs was ablated in only 6/11 patients. CONCLUSION A SharK sequence was developed to combine angiographic and LGE imaging for atrial wall segmentation and scar identification. The PV bullseye quantifies and localizes encirclement about the PVs. The left PVs showed a higher amount of scar encirclement and less variability compared to the right PVs. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:477-486.
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Affiliation(s)
- Adrian Lam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Erica Okene
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Ankit Parikh
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Thor Tejada
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Michael Hoskins
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Michael Lloyd
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - John N Oshinski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
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Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases. Eur Radiol 2016; 27:1954-1962. [PMID: 27553931 DOI: 10.1007/s00330-016-4560-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access. METHODS After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging. RESULTS Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging. CONCLUSIONS Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking. KEY POINTS • Comprehensive CMR-guided electrophysiological interventions including LA access were conducted in swine. • Active catheter-tracking allows efficient catheter navigation also in a transseptal approach. • More MR-conditional tools are needed to facilitate left atrial interventions in humans.
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Rogers T, Mahapatra S, Kim S, Eckhaus MA, Schenke WH, Mazal JR, Campbell-Washburn A, Sonmez M, Faranesh AZ, Ratnayaka K, Lederman RJ. Transcatheter Myocardial Needle Chemoablation During Real-Time Magnetic Resonance Imaging: A New Approach to Ablation Therapy for Rhythm Disorders. Circ Arrhythm Electrophysiol 2016; 9:e003926. [PMID: 27053637 DOI: 10.1161/circep.115.003926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency ablation for ventricular arrhythmias is limited by inability to visualize tissue destruction, by reversible conduction block resulting from edema surrounding lesions, and by insufficient lesion depth. We hypothesized that transcatheter needle injection of caustic agents doped with gadolinium contrast under real-time magnetic resonance imaging (MRI) could achieve deep, targeted, and irreversible myocardial ablation, which would be immediately visible. METHODS AND RESULTS Under real-time MRI guidance, ethanol or acetic acid was injected into the myocardium of 8 swine using MRI-conspicuous needle catheters. Chemoablation lesions had identical geometry by in vivo and ex vivo MRI and histopathology, both immediately and after 12 (7-17) days. Ethanol caused stellate lesions with patchy areas of normal myocardium, whereas acetic acid caused homogeneous circumscribed lesions of irreversible necrosis. Ischemic cardiomyopathy was created in 10 additional swine by subselective transcoronary ethanol administration into noncontiguous territories. After 12 (8-15) days, real-time MRI-guided chemoablation-with 2 to 5 injections to create a linear lesion-successfully eliminated the isthmus and local abnormal voltage activities. CONCLUSIONS Real-time MRI-guided chemoablation with acetic acid enabled the intended arrhythmic substrate, whether deep or superficial, to be visualized immediately and ablated irreversibly. In an animal model of ischemic cardiomyopathy, obliteration of a conductive isthmus both anatomically and functionally and abolition of local abnormal voltage activities in areas of heterogeneous scar were feasible. This represents the first report of MRI-guided myocardial chemoablation, an approach that could improve the efficacy of arrhythmic substrate ablation in the thick ventricular myocardium.
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Affiliation(s)
- Toby Rogers
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Srijoy Mahapatra
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Steven Kim
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Michael A Eckhaus
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - William H Schenke
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Jonathan R Mazal
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Adrienne Campbell-Washburn
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Merdim Sonmez
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Anthony Z Faranesh
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Kanishka Ratnayaka
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Robert J Lederman
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.).
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40
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Whitaker J, Rajani R, Chubb H, Gabrawi M, Varela M, Wright M, Niederer S, O'Neill MD. The role of myocardial wall thickness in atrial arrhythmogenesis. Europace 2016; 18:1758-1772. [PMID: 27247007 DOI: 10.1093/europace/euw014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/13/2016] [Indexed: 01/08/2023] Open
Abstract
Changes in the structure and electrical behaviour of the left atrium are known to occur with conditions that predispose to atrial fibrillation (AF) and in response to prolonged periods of AF. We review the evidence that changes in myocardial thickness in the left atrium are an important part of this pathological remodelling process. Autopsy studies have demonstrated changes in the thickness of the atrial wall between patients with different clinical histories. Comparison of the reported tissue dimensions from pathological studies provides an indication of normal ranges for atrial wall thickness. Imaging studies, most commonly done using cardiac computed tomography, have demonstrated that these changes may be identified non-invasively. Experimental evidence using isolated tissue preparations, animal models of AF, and computer simulations proves that the three-dimensional tissue structure will be an important determinant of the electrical behaviour of atrial tissue. Accurately identifying the thickness of the atrial may have an important role in the non-invasive assessment of atrial structure. In combination with atrial tissue characterization, a comprehensive assessment of the atrial dimensions may allow prediction of atrial electrophysiological behaviour and in the future, guide radiofrequency delivery in regions based on their tissue thickness.
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Affiliation(s)
- John Whitaker
- Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Ronak Rajani
- Department of Cardiac Computed Tomography, Cardiovascular Directorate, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Henry Chubb
- Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.,Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Mark Gabrawi
- Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Marta Varela
- Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Matthew Wright
- Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Steven Niederer
- Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Mark D O'Neill
- Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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41
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Yang Y, Liu Q, Wu Z, Li X, Xiao Y, Tu T, Zhou S. Stiff Left Atrial Syndrome: A Complication Undergoing Radiofrequency Catheter Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:884-9. [PMID: 26920815 DOI: 10.1111/jce.12966] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/28/2016] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
Radiofrequency catheter ablation for atrial fibrillation is an effective approach for treating atrial fibrillation. Its complications have attracted much attention, of which the stiff left atrial syndrome is a recently discovered complication that has not been completely understood. This study aims to investigate the concept, pathologic basis, clinical characteristics, predictors, and treatment protocols of the stiff left atrial syndrome after radiofrequency ablation for atrial fibrillation.
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Affiliation(s)
- Yufan Yang
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Qiming Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhihong Wu
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xuping Li
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yichao Xiao
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Tao Tu
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Shenghua Zhou
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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42
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Barbhayia CR, Kumar S, Michaud GF. Mapping Atrial Fibrillation: 2015 Update. J Atr Fibrillation 2015; 8:1227. [PMID: 27957220 DOI: 10.4022/jafib.1227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/11/2015] [Accepted: 08/16/2015] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation requires a trigger that initiates the arrhythmia and substrate that favors perpetuation. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimized. The most commonly used cardiac mapping approach is isochronal or activation mapping, which aims to create a spatial model of electrical wavefront propagation. Historically, activation mapping has been successful for mapping point source and single or double wave reentrant arrhythmias, while mapping multiple wavelets or driving sources that underlie most episodes of atrial fibrillation remains challenging. In the multiple wavelet model of AF there is no particular area critical to sustain atrial fibrillation, and a "critical mass" of atrium is required to maintain AF. Recent studies suggest endocardial and epicardial dissociation may play an important role. Investigation of driving sources that sustain AF has focused on the presence of rotors. Rotors in human AF have now been observed using multiple imaging modalities, however ablation strategies targeting rotors remain of unproven benefit. In addition, substrate mapping of AF is now feasible. Increasing degrees of atrial fibrosis on delayed enhancement magnetic resonance imaging (DE-MRI) has been shown to correlate with poor procedural outcomes for AF ablation, which suggests the increased burden of scar promotes more complex and extensive arrhythmia substrate. Atrial fibrosis is also identifiable using electrogram voltage tagging in an electro-anatomic mapping system. Patient-specific ablation strategies targeting areas of fibrosis are currently under investigation. Recent technological advances have facilitated greater understanding of the potential role for AF mapping and has allowed initiation of clinical studies to evaluate the effectiveness of mapping-based intervention. Multi-modality mapping is likely to play an increasingly important role in AF ablation, but is currently limited by the inability to simultaneously record and interpret electrical signals from both atria and from both the epicardium and endocardium.
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Affiliation(s)
| | - Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
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43
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Han FT, Marrouche N. An atrial fibrosis-based approach for atrial fibrillation ablation. Future Cardiol 2015; 11:673-81. [DOI: 10.2217/fca.15.65] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since the emergence of atrial fibrillation (AF) ablation as a reliable method of restoring sinus rhythm, various approaches have been used to improve the efficacy while maximizing the safety of ablation. A major hurdle to optimizing outcomes for AF ablation has been the failure to recognize that the substrate of the individual patient plays a significant role in optimizing AF treatment. Using delayed-enhancement MRI for the detection of left atrial fibrosis, our group has been able to correlate these structural remodeling changes to outcomes of stroke, AF recurrence and congestive heart failure. This has provided us with information to optimize care of our AF patients based on screening for a fibrotic atrial cardiomyopathy, for which AF is the arrhythmic manifestation. By employing an MRI-guided approach for AF ablation, we have been able to optimize AF management and enhance the delivery of personalized medicine for our patients.
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Affiliation(s)
- Frederick T Han
- Division of Cardiology, Section of Cardiac Electrophysiology, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A-100 SOM, Salt Lake City, UT 84132, USA
| | - Nassir Marrouche
- Division of Cardiology, Section of Cardiac Electrophysiology, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A-100 SOM, Salt Lake City, UT 84132, USA
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44
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Ohana M, Bakouboula B, Labani A, Jeung MY, El Ghannudi S, Jesel-Morel L, Roy C. Imaging before and after catheter ablation of atrial fibrillation. Diagn Interv Imaging 2015; 96:1113-23. [DOI: 10.1016/j.diii.2014.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/12/2014] [Accepted: 12/22/2014] [Indexed: 02/07/2023]
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45
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Parmar BR, Jarrett TR, Kholmovski EG, Hu N, Parker D, MacLeod RS, Marrouche NF, Ranjan R. Poor scar formation after ablation is associated with atrial fibrillation recurrence. J Interv Card Electrophysiol 2015; 44:247-56. [PMID: 26455362 DOI: 10.1007/s10840-015-0060-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients routinely undergo ablation for atrial fibrillation (AF) but the recurrence rate remains high. We explored in this study whether poor scar formation as seen on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) correlates with AF recurrence following ablation. METHODS We retrospectively identified 94 consecutive patients who underwent their initial ablation for AF at our institution and had pre-procedural magnetic resonance angiography (MRA) merged with left atrial (LA) anatomy in an electroanatomic mapping (EAM) system, ablated areas marked intraprocedurally in EAM, 3-month post-ablation LGE-MRI for assessment of scar, and minimum of 3-months of clinical follow-up. Ablated area was quantified retrospectively in EAM and scarred area was quantified in the 3-month post-ablation LGE-MRI. RESULTS With the mean follow-up of 336 days, 26 out of 94 patients had AF recurrence. Age, hypertension, and heart failure were not associated with AF recurrence, but LA size and difference between EAM ablated area and LGE-MRI scar area was associated with higher AF recurrence. For each percent higher difference between EAM ablated area and LGE-MRI scar area, there was a 7-9% higher AF recurrence (p values 0.001-0.003) depending on the multivariate analysis. CONCLUSIONS In AF ablation, poor scar formation as seen on LGE-MRI was associated with AF recurrence. Improved mapping and ablation techniques are necessary to achieve the desired LA scar and reduce AF recurrence.
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Affiliation(s)
- Bhrigu R Parmar
- CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Tyler R Jarrett
- CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Eugene G Kholmovski
- CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Nan Hu
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dennis Parker
- CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Rob S MacLeod
- CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Nassir F Marrouche
- CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Ravi Ranjan
- CARMA Center, Division of Cardiology, University of Utah, Salt Lake City, UT, 84132, USA.
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Giannakidis A, Nyktari E, Keegan J, Pierce I, Suman Horduna I, Haldar S, Pennell DJ, Mohiaddin R, Wong T, Firmin DN. Rapid automatic segmentation of abnormal tissue in late gadolinium enhancement cardiovascular magnetic resonance images for improved management of long-standing persistent atrial fibrillation. Biomed Eng Online 2015; 14:88. [PMID: 26445883 PMCID: PMC4596471 DOI: 10.1186/s12938-015-0083-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/21/2015] [Indexed: 01/11/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common heart rhythm disorder. In order for late Gd enhancement cardiovascular magnetic resonance (LGE CMR) to ameliorate the AF management, the ready availability of the accurate enhancement segmentation is required. However, the computer-aided segmentation of enhancement in LGE CMR of AF is still an open question. Additionally, the number of centres that have reported successful application of LGE CMR to guide clinical AF strategies remains low, while the debate on LGE CMR’s diagnostic ability for AF still holds. The aim of this study is to propose a method that reliably distinguishes enhanced (abnormal) from non-enhanced (healthy) tissue within the left atrial wall of (pre-ablation and 3 months post-ablation) LGE CMR data-sets from long-standing persistent AF patients studied at our centre. Methods Enhancement segmentation was achieved by employing thresholds benchmarked against the statistics of the whole left atrial blood-pool (LABP). The test-set cross-validation mechanism was applied to determine the input feature representation and algorithm that best predict enhancement threshold levels. Results Global normalized intensity threshold levels TPRE = 1 1/4 and TPOST = 1 5/8 were found to segment enhancement in data-sets acquired pre-ablation and at 3 months post-ablation, respectively. The segmentation results were corroborated by using visual inspection of LGE CMR brightness levels and one endocardial bipolar voltage map. The measured extent of pre-ablation fibrosis fell within the normal range for the specific arrhythmia phenotype. 3D volume renderings of segmented post-ablation enhancement emulated the expected ablation lesion patterns. By comparing our technique with other related approaches that proposed different threshold levels (although they also relied on reference regions from within the LABP) for segmenting enhancement in LGE CMR data-sets of AF patients, we illustrated that the cut-off levels employed by other centres may not be usable for clinical studies performed in our centre. Conclusions The proposed technique has great potential for successful employment in the AF management within our centre. It provides a highly desirable validation of the LGE CMR technique for AF studies. Inter-centre differences in the CMR acquisition protocol and image analysis strategy inevitably impede the selection of a universally optimal algorithm for segmentation of enhancement in AF studies.
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Affiliation(s)
- Archontis Giannakidis
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Eva Nyktari
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Iain Pierce
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Irina Suman Horduna
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Shouvik Haldar
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Dudley J Pennell
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Raad Mohiaddin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Tom Wong
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
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47
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Ipek EG, Nazarian S. Cardiac magnetic resonance for prediction of arrhythmogenic areas. Trends Cardiovasc Med 2015; 25:635-42. [PMID: 25937045 PMCID: PMC4559491 DOI: 10.1016/j.tcm.2015.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 12/20/2022]
Abstract
Catheter ablation has been widely used to manage recurrent atrial and ventricular arrhythmias. It has been established that contrast-enhanced magnetic resonance can accurately characterize the myocardium. In this review, we summarize the role of cardiac magnetic resonance in identification of arrhythmogenic substrates, and the potential utility of cardiac magnetic resonance for catheter ablation of complex atrial and ventricular arrhythmias.
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Affiliation(s)
- Esra Gucuk Ipek
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Saman Nazarian
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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48
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Panovsky R, Pleva M, Feitova V, Kruzliak P, Meluzin J, Kincl V, Novotny P, Vanicek J. Left atrium assessment. J Cardiovasc Med (Hagerstown) 2015; 16:671-80. [DOI: 10.2459/jcm.0000000000000155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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49
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Gal P, Marrouche NF. Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome. Eur Heart J 2015; 38:14-19. [DOI: 10.1093/eurheartj/ehv514] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 11/14/2022] Open
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50
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Khurram IM, Catanzaro JN, Zimmerman S, Zipunnikov V, Berger RD, Cheng A, Sinha S, Dewire J, Marine J, Spragg D, Ashikaga H, Halperin H, Calkins H, Nazarian S. MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1317-24. [PMID: 26171648 DOI: 10.1111/pace.12696] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 05/26/2015] [Accepted: 06/29/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Catheter ablation utilizing radiofrequency (RF), Cryothermal (Cryo), or Laser energy is effective for treatment of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been used to estimate the burden of left atrial (LA) fibrosis, but no data exist regarding structural changes following each modality. We sought to compare the baseline to postprocedure change in LA scar burden following RF, Cryo, or Laser ablation for treatment of AF. METHODS Seventeen patients with AF underwent initial pulmonary vein (PV) isolation (PVI) using RF (n = 7), Cryo (n = 5), and Laser (n = 5). LGE-MRI was performed prior to and at 24 hours and 3 months after PVI. RESULTS In a linear mixed-effects model, accounting for intrapatient clustering of data and interpatient differences in baseline scar, LGE extent was significantly increased at 24 hours postablation (+14.6 ± 1.9% of LA myocardium, P < 0.001), and remained stable from 24 hours to 3 months (+0.12 ± 1.9%, P = 0.951). There was no statistically significant difference between the postablation scar extent among ablation modalities when compared to RF (Cryo +4.5 ± 3.0%, P = 0.123; Laser -3.2 ± 3.0%, P = 0.291). The PV antral LGE intensity was increased by 25.1 ± 3.8% (P<0.001) 24 hours after ablation and additionally increased by 8.1 ± 3.8 at 3 months (P = 0.033). CONCLUSIONS Radiofrequency, Cryo, and laser ablation result in increased LGE extent and intensity at 24 hours and 3 months postablation. No statistically significant difference was noted in the extent of fibrosis induced by any modality.
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Affiliation(s)
- Irfan M Khurram
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John N Catanzaro
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefan Zimmerman
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vadim Zipunnikov
- Department of Biostatistics, The Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Ronald D Berger
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan Cheng
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunil Sinha
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jane Dewire
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Marine
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Spragg
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiroshi Ashikaga
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry Halperin
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saman Nazarian
- Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, Maryland
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