Magnetic resonance imaging of the left atrial appendage post pulmonary vein isolation: Implications for percutaneous left atrial appendage occlusion. Issue 2 (23rd September 2014)

• Record Type: Journal Article
• Authors: Singh, Sheldon M.; Jimenez‐Juan, Laura; Danon, Asaf; Bastarrika, Gorka; Shmatukha, Andriy V.; Wright, Graham A.; Crystal, Eugene
• Is Part Of: Journal of arrhythmia. Volume 31:Issue 2(2015)
• Page Start: 108
• Page End: 113
• Publication Date: 2014-09-23
• Subjects: AF -- atrial fibrillation -- LAA -- left atrial appendage -- RF -- radiofrequency -- LA -- left atrium -- CMR -- cardiovascular magnetic resonance imaging -- PV -- pulmonary vein -- CE‐3D MRA -- contrast enhanced 3‐dimensional magnetic resonance angiography -- DE‐MRI -- delayed enhancement magnetic resonance imaging -- TR -- repetition time -- TE -- echo time -- NEX -- number of excitations -- FOV -- field of view -- IR -- inversion recovery; Atrial fibrillation -- Catheter ablation -- Left atrial appendage occlusion -- Magnetic resonance imaging; Arrhythmia -- Periodicals; Cardiac pacing -- Periodicals; Arrhythmias, Cardiac; Arrhythmia; Cardiac pacing; Periodicals; Electronic journals; Periodicals; 616.128
• DOI: 10.1016/j.joa.2014.08.005
• Languages: English
• ISSNs: 1880-4276

Abstract

Abstract: Background: There is increasing interest in performing left atrial appendage (LAA) occlusion at the time of atrial fibrillation (AF) ablation procedures. However, to date there has been no description of the acute changes to the LAA immediately following pulmonary vein (PV) isolation and additional left atrium (LA) substrate modification. This study assessed changes in the size and tissue characteristics of the LAA ostium in patients undergoing PV isolation. Methods: This series included 8 patients who underwent cardiovascular magnetic resonance evaluation of the LA with delayed enhancement magnetic resonance imaging and contrast enhanced 3‐D magnetic resonance angiography pre‐, within 48 h of, and 3 months post ablation. Two independent cardiac radiologists evaluated the ostial LAA diameters and area at each time point in addition to the presence of gadolinium enhancement. Results: Compared to pre‐ablation values, the respective median differences in oblique diameters and LAA area were +1.8 mm, +1.7 mm, and +0.6 cm 2 immediately post ablation (all NS) and −2.7 mm, −2.3 mm, and −0.5 cm 2 at 3 months (all NS). No delayed enhancement was detected in the LAA post ablation. Conclusion: No significant change to LAA diameter, area, or tissue characteristics was noted after PV isolation. While these findings suggest the safety and feasibility of concomitant PV isolation and LAA device occlusion, the variability in the degree and direction of change of the LAA measurements highlights the need for further study.