Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Detection and Characterization of Left Atrial Catheter Ablation Lesions: A Multicenter Experience. (7th January 2013)

• Record Type: Journal Article
• Authors: HUNTER, ROSS J.; JONES, DANIEL A.; BOUBERTAKH, REDHA; MALCOLME‐LAWES, LOUISA C.; KANAGARATNAM, PRAPA; JULI, CHRISTOPH F.; DAVIES, D. WYN; PETERS, NICHOLAS S.; BAKER, VICTORIA; EARLEY, MARK J.; SPORTON, SIMON; DAVIES, L. CERI; WESTWOOD, MARK; PETERSEN, STEFFEN E.; SCHILLING, RICHARD J.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 24:Number 4(2013:Apr.)
• Page Start: 396
• Page End: 403
• Publication Date: 2013-01-07
• Subjects: Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.12063
• Languages: English
• ISSNs: 1045-3873

Abstract

<abstract abstract-type="main" xml:lang="en"> <title> <x xml:space="preserve">Abstract</x> </title> <p> <bold>MRI Detection of Left Atrial Ablation Lesions</bold>. <bold><italic>Introduction:</italic></bold> We tested the hypothesis that cardiovascular magnetic resonance (CMR) imaging can reliably distinguish the presence or absence of left atrial (LA) ablation lesions by blinded analysis of pre‐ and postablation imaging.</p> <p> <bold> <italic>Methods:</italic> </bold> Consecutive patients at 2 centers undergoing pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation by either wide area circumferential radiofrequency ablation (WACA) or ostial ablation with a cryoballoon underwent CMR late gadolinium enhancement (LGE) imaging pre‐ and 3 months postablation. Imaging was anonymized for blinded analysis of (1) LGE images, and (2) a 3D fusion image with LGE projected onto a segmented LA surface. Scans were categorized using both assessment techniques separately as pre‐ or postablation, and if postablation, whether lesions were in an ostial or WACA distribution.</p> <p> <bold> <italic>Results:</italic> </bold> LGE imaging was performed in 50 patients (aged 60 ± 10 years, 68% male, 24 underwent WACA and 26 had cryoablation). Sensitivity and specificity for detection of ablation lesions was 60% and 96% on LGE imaging. Sensitivity was higher using 3D fusion imaging (88%; P = 0.003). The proportion in whom lesions were both detected and the distribution correctly assessed as WACA or ostial was higher with 3D fusion imaging compared to LGE imaging (54% vs 28%; P = 0.014). There was no difference in the detection of radiofrequency ablation lesions compared to cryoablation lesions (58% vs 62%; P = 1.000).</p> <p> <bold> <italic>Conclusion:</italic> </bold> LGE imaging of atrial scar is not yet sufficiently accurate to reliably identify ablation lesions or to determine lesion distribution. <italic>(J Cardiovasc Electrophysiol, Vol. 24, pp. 396‐403, April 2013)</italic></p> </abstract>