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Ishidoya Y, Kwan E, Hunt B, Lange M, Sharma T, Dosdall DJ, Macleod RS, Kholmovski EG, Bunch TJ, Ranjan R. Effective ablation settings that predict chronic scar after atrial ablation with HELIOSTAR™ multi-electrode radiofrequency balloon catheter. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01948-y. [PMID: 39592538 DOI: 10.1007/s10840-024-01948-y] [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] [Received: 02/29/2024] [Accepted: 11/12/2024] [Indexed: 11/28/2024]
Abstract
BACKGROUND Radiofrequency balloon (RFB) ablation (HELIOSTAR™, Biosense Webster) has been developed to improve pulmonary vein ablation efficiency over traditional point-by-point RF ablation approaches. We aimed to find effective parameters for RFB ablation that result in chronic scar verified by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). METHODS A chronic canine model (n = 8) was used to ablate in the superior vena cava (SVC), the right superior and the left inferior pulmonary vein (RSPV and LIPV), and the left atrial appendage (LAA) with a circumferential ablation approach (RF energy was delivered to all electrodes simultaneously) for 20 s or 60 s. The electroanatomical map with the ablation tags was projected onto the 3-month post-ablation LGE-CMR. Tags were divided into two groups depending on whether they correlated with CMR-based scar (ScarTags) or non-scar tissue (Non-ScarTags). The effective parameters for scar formation were estimated by multivariate logistic regression. RESULTS This study assessed 80 lesions in the SVC, 80 lesions in the RSPV, 20 lesions in the LIPV, and 30 lesions in the LAA (168 ScarTags and 42 Non-ScarTags). In the multivariate analysis, two variables were associated with chronic scar formation: temperature of electrode before energy application (odds ratio (OR) 0.805, p = 0.0075) and long RF duration (OR 2.360, p = 0.0218), whereas impedance drop was not associated (OR 0.986, p = 0.373). CONCLUSION Lower temperature of the electrode before ablation and long ablation duration are critical parameters for durable atrial scar formation with RFB ablation.
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Affiliation(s)
- Yuki Ishidoya
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Eugene Kwan
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Bram Hunt
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Matthias Lange
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | | | - Derek J Dosdall
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Division of Cardiothoracic Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rob S Macleod
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Eugene G Kholmovski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, 30 N 1900 E Rm 4A100, Salt Lake City, UT, 84132-2101, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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Dong J, Kwan E, Bergquist JA, Steinberg BA, Dosdall DJ, DiBella EVR, MacLeod RS, Bunch TJ, Ranjan R. Ablation-induced left atrial mechanical dysfunction recovers in weeks after ablation. J Interv Card Electrophysiol 2024; 67:1547-1556. [PMID: 38587576 DOI: 10.1007/s10840-024-01795-x] [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: 07/20/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The immediate impact of catheter ablation on left atrial mechanical function and the timeline for its recovery in patients undergoing ablation for atrial fibrillation (AF) remain uncertain. The mechanical function response to catheter ablation in patients with different AF types is poorly understood. METHODS A total of 113 AF patients were included in this retrospective study. Each patient had three magnetic resonance imaging (MRI) studies in sinus rhythm: one pre-ablation, one immediate post-ablation (within 2 days after ablation), and one post-ablation follow-up MRI (≤ 3 months). We used feature tracking in the MRI cine images to determine peak longitudinal atrial strain (PLAS). We evaluated the change in strain from pre-ablation, immediately after ablation to post-ablation follow-up in a short-term study (< 50 days) and a 3-month study (3 months after ablation). RESULTS The PLAS exhibited a notable reduction immediately after ablation, compared to both pre-ablation levels and those observed in follow-up studies conducted at short-term (11.1 ± 9.0 days) and 3-month (69.6 ± 39.6 days) intervals. However, there was no difference between follow-up and pre-ablation PLAS. The PLAS returned to 95% pre-ablation level within 10 days. Paroxysmal AF patients had significantly higher pre-ablation PLAS than persistent AF patients in pre-ablation MRIs. Both type AF patients had significantly lower immediate post-ablation PLAS compared with pre-ablation and post-ablation PLAS. CONCLUSION The present study suggested a significant drop in PLAS immediately after ablation. Left atrial mechanical function recovered within 10 days after ablation. The drop in PLAS did not show a substantial difference between paroxysmal and persistent AF patients.
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Affiliation(s)
- Jiawei Dong
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Eugene Kwan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jake A Bergquist
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University fo Utah, Salt Lake City, UT, USA
| | - Edward V R DiBella
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Rob S MacLeod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
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Krahn PRP, Escartin T, Singh SM, Barry J, Larsen M, Guo F, Pop M, Wright GA. MRI Accurately Visualizes RF Ablation Delivery Targeted to MRI-Defined Arrhythmia Substrates in the Left Ventricle. IEEE Trans Biomed Eng 2024; 71:2749-2758. [PMID: 38648149 DOI: 10.1109/tbme.2024.3392333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Investigate the capacity of MRI to evaluate efficacy of radiofrequency (RF) ablations delivered to MRI-defined arrhythmogenic substrates. METHODS Baseline MRI was performed at 3 T including 3D LGE in a swine model of chronic myocardial infarct (N = 8). MRI-derived maps of scar and heterogeneous tissue channels (HTCs) were generated using ADAS 3D. Animals underwent electroanatomic mapping and ablation of the left ventricle in CARTO3, guided by MRI-derived scar maps. Post-ablation MRI (in vivo at 3 T in 5/8 animals; ex vivo at 1.5 T in 3/8) included 3D native T1-weighted IR-SPGR (TI = 700-800 ms) to visualize RF lesions. T1-derived RF lesions were compared against excised tissue. The locations of T1-derived RF lesions were compared against CARTO ablation tags, and segment-wise sensitivity and specificity of lesion detection were calculated within the AHA 17-segment model. RESULTS RF lesions were clearly visualized in HTCs, scar, and myocardium. Ablation patterns delivered in CARTO matched T1-derived RF lesion patterns with high sensitivity (88.9%) and specificity (94.7%), and were closely matched in registered MR-EP data sets, with a displacement of 5.4 ±3.8 mm (N = 152 ablation tags). CONCLUSION Integrating MRI into ablative procedures for RF lesion assessment is feasible. Patterns of RF lesions created using a standard 3D EAM system are accurately reflected by MRI visualization in healthy myocardium, scar, and HTCs comprising the MRI-defined arrhythmia substrate. SIGNIFICANCE MRI visualization of RF lesions can provide near-immediate ( 24 h) assessment of ablation, potentially indicating whether critical MRI-defined ventricular tachycardia substrates have been adequately ablated.
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Jin G, Li S, Wang Y, Pu J. Case report: Cardiac arrest after radiofrequency ablation in a 76-year-old male. Medicine (Baltimore) 2024; 103:e37191. [PMID: 38394505 PMCID: PMC11309667 DOI: 10.1097/md.0000000000037191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
RATIONALE Previous studies have found that the main treatment of sinus arrest is pacemaker treatment. It is rare to have 12 s of sinus arrest after radiofrequency ablation, and whether a permanent pacemaker is implanted immediately in this case is not described in the guidelines. PATIENT CONCERNS A 76-year-old male patient with persistent atrial fibrillation (AF) developed sinus arrest lasting 12 s in the early morning of the fourth day after using radiofrequency ablation for pulmonary vein isolation. DIAGNOSIS The patient was diagnosed with AF and sinus arrest. INTERVENTIONS The patient received cardiopulmonary resuscitation, intravenous injection of atropine 1 mg, and intravenous infusion of isoproterenol 1mg and immediately recovered consciousness thereafter. Approximately, 1.5 h later, the patient underwent surgery to install a temporary pacemaker in the right femoral vein. OUTCOMES The patient had repeated episodes of sinus arrest after the implantation of a temporary pacemaker. After 3 weeks, the patient stabilized and was discharged. The patient was followed up for 1 year and did not experience any recurrence of sinus arrest or AF. LESSONS We consider the potential for postoperative myocardial edema, injury to the sinoatrial node during the procedure, propafenone poisoning, and autonomic dysfunction as contributors to the occurrence of sinus arrest after radiofrequency ablation. When sinus arrest occurs after radiofrequency ablation, we can choose the appropriate treatment according to the patient's condition.
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Affiliation(s)
- Geya Jin
- North China University of Science and Technology, Tangshan, China
| | - Shuyu Li
- Tangshan Workers’ Hospital, Tangshan, China
| | - Yafeng Wang
- North China University of Science and Technology, Tangshan, China
| | - Jianyi Pu
- Affiliated Hospital of North China University of Science and Technology, Tangshan, China
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Krahn PRP, Biswas L, Ferguson S, Ramanan V, Barry J, Singh SM, Pop M, Wright GA. MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions. IEEE Trans Biomed Eng 2022; 69:2657-2666. [PMID: 35171765 DOI: 10.1109/tbme.2022.3152145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective: Radiofrequency (RF) energy delivered to cardiac tissue produces a core ablation lesion with surrounding edema, the latter of which has been implicated in acute procedural failure of Ventricular Tachycardia (VT) ablation and late arrhythmia recurrence. This study sought to investigate the electrophysiological characteristics of acute RF lesions in the left ventricle (LV) visualized with native-contrast Magnetic Resonance Imaging (MRI). Methods: An MR-guided electrophysiology system was used to deliver RF ablation in the LV of 8 swine (9 RF lesions in total), then perform MRI and electroanatomic mapping. The permanent RF lesions and transient edema were delineated via native-contrast MRI segmentation of T1-weighted images and T2 maps respectively. Bipolar voltage measurements were matched with image characteristics of pixels adjacent to the catheter tip. Native-contrast MR visualization was verified with 3D late gadolinium enhanced MRI and histology. Results: The T2-derived edema was significantly larger than the T1-derived RF lesion (2.11.5 mL compared to 0.580.34 mL; p=0.01). Bipolar voltage was significantly reduced in the presence of RF lesion core (p<0.05) and edema (p<0.05), with similar trends suggesting that both the permanent lesion and transient edema contributed to the region of reduced voltage. While bipolar voltage was significantly decreased where RF lesions are present (p<0.05), voltage did not change significantly with lesion transmurality (p>0.05). Conclusion: Permanent RF lesions and transient edema are distinct in native-contrast MR images, but not differentiable using bipolar voltage. Significance: Intraprocedural native-contrast MRI may provide valuable lesion assessment in MR-guided ablation, whose clinical application is now feasible.
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Optimal Ablation Settings Predicting Durable Scar Detected Using LGE-MRI after Modified Left Atrial Anterior Line Ablation. J Clin Med 2022; 11:jcm11030830. [PMID: 35160281 PMCID: PMC8837068 DOI: 10.3390/jcm11030830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The modified anterior line (MAL) has been described as an alternative to the mitral isthmus line. Despite better ablation results, achieving a bidirectional line block can be challenging. We aimed to investigate the ablation parameters that determine a persistent scar on late-gadolinium enhancement magnet resonance imaging (LGE-MRI) as a surrogate parameter for successful ablation 3 months after MAL ablation. (2) Methods: Twenty-four consecutive patients who underwent a MAL ablation have been included. The indication for MAL was perimitral flutter (n = 5) or substrate ablation in the diffuse anterior left atrial (LA) low-voltage area in persistent atrial fibrillation (AF) (n = 19). The MAL was divided into three segments: segment 1 (S1) from mitral annulus to height of lower region of left atrial appendage (LAA) antrum; segment 2 (S2) height of lower region of LAA antrum to end of upper LAA antrum; segment 3 (S3) from end of upper LAA antrum to left superior pulmonary vein. Ablation was performed using a contact force irrigated catheter with a power of 40 Watt and guided by automated lesion tagging and the Ablation Index (AI). The AI target was left to the operator’s choice. An inter-lesion distance of ≤6 mm was recommended. The bidirectional block was systematically evaluated using stimulation maneuvers at the end of procedure. All patients underwent LGE-MRI imaging at 3 months, regardless of symptoms, to identify myocardial lesions (scars). (3) Results: Bidirectional MAL block was achieved in all patients. LGE-MRI imaging revealed scarring in 45 of 72 (63%) segments. In all three segments of MAL, ablation time and AI were significantly higher in scarred areas compared with non-scar areas. The mean AI value to detect a durable scar was 514.2 in S1, 486.7 in S2 and 485.9 in S3. The mean ablation time to detect a scar was 20.4 s in S1, 22.1 s in S2 and 20.2 s in S3. Mean contact force and impedance drop were not significantly different between scar and non-scar areas. (4) Conclusions: Targeting optimal AI values is crucial to determine persistent left atrial scars on an LGE-MRI scan 3 months after ablation. AI guided linear left atrial ablation seems to be effective in producing durable lesions.
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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: 2] [Impact Index Per Article: 0.7] [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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Role of Imaging in Improving Outcomes with Ablation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00835-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yamashita K, Kamali R, Kwan E, MacLeod RS, Dosdall DJ, Ranjan R. Effective Ablation Settings That Predict Chronic Scar After Left Atrial Ablation. JACC Clin Electrophysiol 2020; 6:143-152. [DOI: 10.1016/j.jacep.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
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Yamashita K, Ranjan R. Imaging for Risk Stratification in Atrial Fibrillation with Heart Failure. Cardiol Clin 2019; 37:147-156. [PMID: 30926016 PMCID: PMC6446587 DOI: 10.1016/j.ccl.2019.01.007] [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] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and is associated with heart failure (HF). Cardiac imaging modalities play an important role in risk assessment and managing AF. This article reviews the use of cardiac imaging for risk assessment and to optimize treatment strategy in patients with AF and HF. First, the clinical role of echocardiography, computed tomography, and cardiac magnetic resonance for risk stratification is provided. Second, the value of imaging in catheter ablation is reviewed, including preoperative assessment, optimizing patient selection for ablation, use during the ablation procedure, and postoperative scar assessment.
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Affiliation(s)
- Kennosuke Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, 30 N 1900 E, Room 4A100, Salt Lake City, Utah 84132, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 South 2000 East, Salt Lake City, UT 84112, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, 30 N 1900 E, Room 4A100, Salt Lake City, Utah 84132, USA; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, 95 South 2000 East, Salt Lake City, UT 84112, USA; Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112, USA.
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Wright GA, Krahn PRP, Glover BM. Magnetic Resonance Imaging: A New Gold Standard for Radiofrequency Ablation Assessment in Ventricular Arrhythmia Treatments? JACC Clin Electrophysiol 2019; 5:101-103. [PMID: 30678773 DOI: 10.1016/j.jacep.2018.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Graham A Wright
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Philippa R P Krahn
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benedict M Glover
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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12
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Yamashita K, Kholmovski E, Ghafoori E, Kamali R, Kwan E, Lichter J, MacLeod R, Dosdall DJ, Ranjan R. Characterization of edema after cryo and radiofrequency ablations based on serial magnetic resonance imaging. J Cardiovasc Electrophysiol 2018; 30:255-262. [PMID: 30375090 DOI: 10.1111/jce.13785] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Radiofrequency (RF) and cryoablation are routinely used to treat arrhythmias, but the extent and time course of edema associated with the two different modalities is unknown. Our goal was to follow the lesion maturation and edema formation after RF and cryoablation using serial magnetic resonance imaging (MRI). METHODS AND RESULTS Ventricular ablation was performed in a canine model (n = 11) using a cryo or an irrigated RF catheter. T2-weighted (T2w) edema imaging and late gadolinium enhancement (LGE)-MRI were done immediately (0 day: acute), 1 to 2 weeks (subacute), and 8 to 12 weeks (chronic) after ablation. After the final MRI, excised hearts underwent pathological evaluation. As a result, 45 ventricular lesions (cryo group: 20; RF group: 25) were evaluated. Acute LGE volume was not significantly different but acute edema volume in cryo group was significantly smaller (1225.0 ± 263.5 vs 1855.2 ± 520.5 mm3 ; P = 0.01). One week after ablation, edema still existed in both group but was similar in size. Two weeks after ablation there was no edema in either of the groups. In the chronic phase, the lesion volume for cryo and RF in LGE-MRI (296.7 ± 156.4 vs 281.6 ± 140.8 mm3 ; P = 0.73); and pathology (243.3 ± 125.9 vs 214.5 ± 148.6 mm3 ; P = 0.49), as well as depth, was comparable. CONCLUSIONS When comparing cryo and RF lesions of similar chronic size, acute edema is larger for RF lesions. Edema resolves in both cryo and RF lesions in 1 to 2 weeks.
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Affiliation(s)
- Kennosuke Yamashita
- Department of Medicine, 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
| | - Eugene Kholmovski
- Department of Radiology and Imaging Sciences, UCAIR, University of Utah, Salt Lake City, Utah.,CARMA Center, Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Elyar Ghafoori
- Department of Medicine, 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.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Roya Kamali
- Department of Medicine, 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.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Eugene Kwan
- Department of Medicine, 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.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Justin Lichter
- Department of Medicine, 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
| | - Robert MacLeod
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Derek J Dosdall
- Department of Medicine, 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.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah.,Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Department of Medicine, 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.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
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Preoperative imaging in search of ventricular tachycardia circuit. Heart Rhythm 2018; 16:595-596. [PMID: 30445169 DOI: 10.1016/j.hrthm.2018.11.012] [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: 11/06/2018] [Indexed: 11/24/2022]
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